Epidural Steroid Injections
An Epidural Steroid Injection (ESI) refers to the injection of corticosteroids and anesthetic solutions into the epidural space of the spine to treat irritated or compressed nerves. When a disk tears, the gelatinous nucleus contained inside the disk leaks out of a tear in the wall of the herniated disk and causes a localized inflammatory reaction. This creates swelling and pressure on the nearby nerve roots. The injection of steroids directly around the nerve roots near the disk herniation helps reduce this inflammation by decreasing swelling, separating adherent tissue, and washing away waste products. The reduced swelling is believed to allow for improved circulation and accelerate the healing process. Corticosteroids may also act like a local anesthetic and block the pain long enough to allow the body to begin the process of repairing itself. The effect may not be long lasting and differs from person to person. Most patients will receive good relief for several weeks or months after an injection. The pain reduction allows the patient to participate more fully in rehabilitation efforts, such as exercise and physical therapy.
How is an Epidural Steroid Injection administered?
Occasionally, a second or third injection may be recommended, depending on the results of the first injection. Most patients respond well to two injections. Occasionally more than three injections be justified within a three to six month period. Sometimes other solutions are added, such as Hyaluronidase to breakup scar tissue, or Ozone (much more common in Europe). When epidural injections are not helpful, a thorough search for other sources of pain is appropriate.
Risks of Epidural Steroid Injections
With any medical or surgical procedure, there are risks. In the case of epidural steroid injections, these risks are generally small and infrequent, and may include the following:
Temporary increase in pain or nerve irritation
Headache, which may last a few hours to a few days
Hot / flushed sensation in the face or chest
Excessive energy, sleeplessness, or irritability for several days
Itching, bruising, or rash
Light-headedness, which usually resolves in 15-30 minutes
Fluid retention or mild weight gain
Nerve or spinal cord compression from an expanding blood clot in the cervical region
Diabetics may experience elevated blood sugar for several days and dosage adjustments of diabetic medications may be necessary during those days.
Discontinue all blood thinners, such as Coumadin, Aspirin, Plavix, and anti-inflammatory medication, for several days before the procedure. This decreases the likelihood that a blood clot could form causing spinal cord compression. These may be resumed after the injection.
Please ensure that transportation home is available following the procedure and allow approximately two hours in all for the procedure, which allows for 30 minutes or more of supervision in the waiting room following the procedure.
You may eat or drink your normal diet before and after the procedure, and resume normal activity afterwards.
Try to relax in the days & nights before your procedure. You will very likely find it minimally uncomfortable, easier than you expected, and very beneficial for your problem.