What is an Epidural Steroid Injection?
Epidural Steroid Injections (ESI) are typically used to reduce low back or leg pain. The injections work by reducing the inflammation (swelling and irritation) of the nerve roots that exit the spine. The goal is to inject the medication directly into the area that is affected. A lumbar epidural is administered to treat lower back problem such as spinal stenosis and sciatica. A cervical epidural is adminstered around the nerves in the neck.

What medications are used?
The corticosteroid that is used is called Celestone. It is a medication that helps decrease the inflammation in the area of the nerve roots. As with all medications, it can have some side effects, including increasing your blood sugar and fluid retention.

What are the risks?
This procedure is safe, but as with any procedure there are risks. Although very rare (1%), a dural puncture can occur. (This rate is higher in people who have had previous back surgery). If this does occur you may develop a spinal headache, which may be severe and may last for days. If the headache does not improve in 48 hours, the treatment is an epidural blood patch. Other risks are less common but include infection, nerve injury, bleeding and reaction to the medication.

How is the medication administered?
You will be asked to sign a consent form and your blood pressure and pulse will be taken. In the majority of cases you will be asked to lie on your stomach on a special x-ray bed. After you are positioned and the injection site is identified, the area is prepped with an antiseptic solution and draped with a sterile drape. A numbing medication will be injected under the skin. A special needle is then placed in the epidural space using fluoroscopy (x-ray) guidance. Once the needle is correctly placed the medication will be injected. The skin is cleansed and a small dressing is applied to the injection site (you may remove the dressing and wash the site the next day). After your vital signs are taken and you feel like leaving, you will be discharged. The procedure usually takes 20 to 30 minutes.

How will I feel after the injection?
The medication takes a few days to start having an effect. Therefore, it may be 2 to 3 days before you have any relief from your pain. If you have any soreness at the injection site you may use an ice pack for 10 minutes, two to three times a day.

What are the benefits and how effective are the injections?
The goal of the ESI is to relieve your pain, not cure the cause of your pain. Patients seem to have better results when the injections are combined with physical therapy. Your doctor will prescribe a comprehensive treatment plan for you. Approximately 60% of patients receiving ESI have some relief from their pain. In most cases the injections are given in a series of three, about a week to two weeks apart. People who have had pain recently respond better than those who have had pain for over a year or more.

Who shouldn’t have an Epidural Steroid Injection?
Anyone who is currently taking blood thinners such as coumadin (warfarin) and plavix, who have an infection or fever, and women who are pregnant should not have an ESI.

For what reason should I call my doctor after the injection?
You should contact your physician if you are having any of the following:
•• Intense and prolonged headache
•• Redness or warmth at the injection site
•• Fever
•• Loss of bladder or bowl control
•• New numbness in your legs or severe back pain

What restrictions will I have after the injection?
It is suggested that you bring a driver with you. This is for your safety.

You may eat, drink and take your medications both before and after the injection, unless otherwise directed by your physician.

Avoid heating pads on the injection site and soaking in the bathtub or hot tub for the rest of the day.

Engaging in moderate activity after your injection is acceptable. Excessive or improper activities can worsen your pain. Adjust your activities accordingly. Your compliant participation in your care will give the injection the best chance to work for you.