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Epidural Steroid Injection

What is an Epidural Steroid Injection?

Epidural steroid injections are a common and minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. The spinal nerves become inflamed due to narrowing of the passages where the nerves travel as they pass down or out of the spine. These injections can be highly effective because it delivers the anti-inflammatory medication and pain relief directly to the source of the problem.

The medicine is distributed to the spinal nerve through the epidural space, which is the area between the protective covering of the spinal cord and vertebrae.

epidural-steroid-injectionThis can help control local inflammation while also “flushing out” inflammatory proteins and chemicals from the local area that may contribute to and intensify pain.

What medication is used?

An epidural steroid injection includes both a long-lasting corticosteroid (betamethasone) and an anesthetic, or numbing agent (lidocaine or bupivacaine). The drugs are delivered into the epidural space of the spine.

Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine or bupivacaine), and/or saline is used.

  • A steroid, or cortisone, is usually injected as an anti-inflammatory agent. Inflammation is a common component of many neck and lower back conditions. Reducing inflammation helps reduce pain. Dexamethasone, or Betamethasone is the steroid used during this procedure.
  • Lidocaine is a fast-acting local anesthetic (numbing agent) used for temporary pain relief. Bupivacaine, a longer lasting medication, may also be used.
  • Saline or Isovue is used to dilute the local anesthetic or as a ‘flushing’ agent to dilute the chemical or immunologic agents that promote inflammation.

How is the Procedure done?

  1. Utah Spine Care uses fluoroscopy (live x-ray guidance) for all of the epidural steroid injection procedures.
  2. Using the fluoroscopy is key for helping the physician guide the needle to the exact position.
  3. The patient will lie on a bed on his or her stomach.
  4. The physician will place a small pillow under the stomach of the patient to help raise the spine.
  5. Once your physician has found the correct spot, he or she will start the procedure.
  6. Your Physician will direct a spinal needle into the skin and then toward the epidural space of the spine.
  7. Once the needle has reached the epidural space, the steroid solution is injected.

Patients are not deeply sedated or completely asleep for this procedure, because it is unnecessary to do so. The patient, however, is welcome to take an anti-anxiety agent to help with the possible nerves of this procedure. Our office may provide an anti-anxiety agent if necessary.
The procedure usually takes no more than 5-10 minutes, followed by a brief 15-20 minute recovery before discharge home.

How can you heal after the procedure?

This injection, like many others, will create soreness around injection site. It typically takes 3 to 5 days for the steroid medication to decrease inflammation in the problem area. In the first 5-7 days after the injection, your pain may get worse, before getting better. This is caused by irritation from the needle being placed close to the nerve. Medication will not be prescribed specifically after this procedure.

Patients are not required to rest on the day of the procedure. Most patients go back to work, but work with slight limitations. The following day, all regular activities can be resumed. Because some medications may affect a patient’s driving reflexes, the patient will need someone to drive them home from the office. You should not drive the day of the procedure. You may experience arm or leg weakness/numbness during the first 24 hours following the procedure. Even if you feel better right away, avoid activities that may strain your back.