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 Epidural steroid injections

An epidural injection is typically used to alleviate chronic low back and/or leg pain. While the effects of the injection tend to be temporary - providing relief from pain for one week up to one year - an epidural can be very beneficial for patients during an episode of severe back pain. Importantly, it can provide sufficient pain relief to allow the patient to progress with their rehabilitation program.

What is an epidural steroid injection?

An epidural is an injection that delivers steroids directly into the epidural space in the spine.
The epidural space is the space between the dura membrane (outer covering of the spinal cord and nerve roots) and the vertebral wall and is filled with fat and small blood vessels.

How does an epidural steroid work?

There are often inflammatory factors and other substances that generate pain that are associated with a lumbar disc herniation, lumbar canal stenosis and this inflammation can cause significant nerve root irritation and swelling.
Steroids reduce inflammation by inhibiting the production of substances that cause inflammation; the epidural steroid injection can be highly effective because it delivers the medication directly to the site of inflammation

When is an epidural steroid injection typically recommended?
Several common conditions—including a lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis—can cause severe acute or chronic low back pain and/or leg pain. In these conditions, an epidural steroid injection may be an effective non-surgical treatment option.

How is the epidural steroid injection performed?
An epidural steroid injection usually takes between 15 and 30 minutes. The patient lies down on his or her side. The procedure is performed under local anaesthesia (painless procedure). A needle is introduced into the epidural space and the medication is injected. A small dressing is then applied to the injection site. After the injection the patient is kept under observation for an hour and then discharged home. Sedation during the procedure is available for patient anxiety and comfort.
Patients are usually asked to rest on the day of the epidural steroid injection. Normal activities may typically be resumed the following day.

What are the benefits of an epidural steroid injection?
Patients will find that the benefits of an epidural steroid injection include a reduction in pain, primarily in leg pain. While the effects of an epidural steroid injection tend to be temporary—providing relief from pain for one week up to one year—an epidural injection can be very beneficial for patients during an episode of severe back pain. Importantly, it can provide sufficient pain relief to allow the patient to progress with their rehabilitation program. An epidural steroid injection is generally successful in relieving pain for approximately 50% of patients. If a patient does not experience any back pain or leg pain relief from the first epidural injection, further injections will probably not be beneficial. However, if there is some improvement in back pain or leg pain, one to two additional epidural steroid injections may be recommended.

What are potential risks and side effects of an epidural steroid injection?
As with all invasive medical procedures, there are potential risks associated with lumbar epidural steroid injections. Generally, however, there are few risks associated with epidural steroid injections and they tend to be rare. Risks may include:

Infection
Minor infections occur in 1% to 2% of all injections.

Bleeding
Bleeding is a rare complication and is more common for patients with underlying bleeding disorders or in patients on asprin, antiplatelet drugs.

Nerve damage
While extremely rare, nerve damage can occur from direct trauma from the needle, or secondarily from infection or bleeding. Paralysis is not a risk since there is no spinal cord in the region of the epidural steroid injection.

Dural puncture
A dural puncture occurs in 0.5% of injections. It may cause a spinal headache (post-dural puncture headache) that usually gets better within a few days.

Side effects from the steroid medication
A transient elevation of blood sugars (especially in diabetics), gastritis may be encountered. The side effects from the steroid in an epidural injection are uncommon and unlike those inpatients on prolonged steroid therapy.
 
Who should avoid epidural steroid injections?
Lumbar epidural steroid injections should not be performed on patients who have a local or systemic bacterial infection, bleeding problems (e.g. Haemophilia), if the pain is from a infection / tumor or in patients with allergies to the injected solution.
Caution is advised in for patients with, uncontrolled medical problems (such as congestive heart failure and diabetes), and those who are taking aspirin or other antiplatelet drugs.

How frequently can epidural steroid injections be performed?
In general, it is considered reasonable to perform up to three epidural injections per year. If a single injection gives adequate relief of symptoms further injections may not be required.