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Overview of Epidural Steroid Injections for Pinched Nerves

Wpinal nerves and spinal fluid travel through the spine encased within a membrane known as the dura. Even though this dural membrane protects the nerves, certain disorders outside of the dura, in the epidural space, can compress or irritate the nerves within.

The most common of these disorders are herniated or slipped discs, spinal stenosis, and bone spurs.

When a spinal nerve becomes pinched by one of these disorders, inflammation results, causing pain wherever the nerve travels (radiculopathy, sciatica) into the arm or leg.

Fortunately, most cases of pain from a pinched or inflamed nerve are mild or resolve quickly. For some patients, however, pain can be quite disabling, or does not improve within a reasonable amount of time. For these patients, an epidural steroid injection can provide adequate pain relief so they can return to normal functioning.

Steroids reduce inflammation and pain very effectively. When taken in pill form, only a small amount is delivered to the target area, while the rest is absorbed into the body, with possible side effects. When steroid is delivered to the target area by injection, into the epidural space, a greater effect can be achieved while reducing exposure to the entire body.

Who benefits from Epidural Steroid Injection?

Any patient with severe nerve pain caused by a pinched nerve in the spine can obtain relief with an epidural steroid injection. However, certain conditions must be met in order to maximize safety. If the space occupied by the nerve is too tight, injecting an additional volume of medication into the space may damage the nerve. Such cases may require surgery. Similarly, if the nerve already appears to damaged, with evidence of muscle weakness, surgery may be the best option to save the nerve. Overall, surgical cases are rare.

The most common regions for epidural steroid injections are in the cervical spine (neck) and lumbar spine (lower back).

How are Epidural Steroid Injections performed?

njections are performed in a sterile procedure room by passing a needle through the skin and muscle overlying the spine. The exact target area is located using x-ray guidance, known as fluoroscopy. Sometimes, the needle is placed in the midline (intralaminar approach). In other instances, the needle is placed from one side (transforaminal approach). The patient’s pain (unilateral or bilateral) and MRI findings guide the approach.

How often can Epidural Steroid Injections be performed?

Typically, epidural steroid injections are performed in sets of three or four, spaced one or two weeks apart. It is not advisable to have more than two sets of injections per year.

Not everyone responds to an epidural steroid injection. If the first injection has no effect, there is no need to repeat it, and a different type of treatment should be considered. Conversely, if the first injection provides complete relief, repeat injections are unnecessary unless symptoms return.

For most patients, the first injection may provide partial but noticeable relief. In such cases, it is reasonable to undergo repeat injections to obtain additional benefit.

Contraindications

Epidural steroid injections should be avoided if you have systemic infection or infection at the site of the skin where the needle will be inserted. Patients on blood thinners, such as Coumadin or Plavix, have an increased risk of dangerous bleeding from epidural steroid injection. These medications are often stopped 7-10 days before the procedure, depending on the patient and practitioner.

Pregnant women should avoid these injections because of exposure to radiation.

Before an Epidural Steroid Injection

Inform your doctor about the following:

  • Use of blood thinners such as Coumadin, Plavix, Xarelto, or Eliquis, as they can cause excessive bleeding.
  • Allergies to shellfish or contrast dye. You may need to take medications before the procedure to prevent allergic reactions.
  • Pregnancy or the chance of pregnancy.
  • Infections or antibiotic use.

You will need to avoid eating or drinking from 6-8 hours before the procedure. Medications may be taken with a sip of water.

After an Epidural Steroid Injection

You may notice some pain relief for the first few hours after the procedure due to local anesthetic effect. Your pain may return to preinjection level once local anesthetic wears off. It usually takes 3-5 days to notice improvement, but some people may experience improvement before or after this time period. Patients are not able to return to work after the procedure, but most people do return to work the next day.

When you return to home:

  • Rest and relax.
  • Apply ice packs on for 15 minutes at a time, and repeat every 2-3 hours for the first 24 hours to relieve discomfort at the injection site.
  • Apply heating pad if pain persists after 24 hours.
  • Take pain medication if necessary.

Potential Complications

In general, epidural steroid injections are routine and very safe. However, because these are invasive procedures, complications can occur, albeit rarely.

Risks include infection, bleeding, allergic reaction to medication, nerve damage, and spinal fluid leak. Fortunately, when these rare events occur, they can be managed effectively and rapidly.

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