What is an epidural steroid injection (ESI)?
A steroid injection includes both a corticosteroid (e.g., triamcinolone, methyl-prednisolone, dexamethasone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the bony vertebra and the protective dura sac surrounding the spinal nerves and cord
Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves by flushing away the proteins that cause swelling. The pain relief can last from days to years, allowing your spinal condition to improve with physical therapy and an exercise program.
Who is a candidate?
Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:
What happens before treatment?
The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions at this appointment.
Patients who take take blood thinning medication (Coumadin, Plavix, etc.) may need to stop taking it several days before the ESI. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.
The procedure is usually performed in an outpatient center using x-ray fluoroscopy. Make arrangements to have someone drive you to and from the center the day of the injection.
What happens during treatment?
At the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication.
The goal is to inject the medication as close to the painful nerve as possible. The type of injection depends on your condition.The doctor will decide which type is likely to produce the best results.
Step 1: prepare the patient
The patient lies on an x-ray table. Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains awake and aware during the injection to provide feedback to the physician.
Step 2: insert the needle
With the aid of an x-ray fluoroscope, the doctor directs a hollow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy allows the doctor to watch the needle in real-time on the x-ray monitor, ensuring that the needle goes to the desired location. Some discomfort occurs, but patients more commonly feel pressure than pain.
********* There are several types of ESIs:
Figure 2. An ESI injection in the cervical spine for neck or arm pain. The needle is inserted from the side of the neck to reach the neural foramen to deliver the steroid medication (green) where the inflamed nerve root exits the spine
Figure 3. An ESI injection in the lumbar spine for leg or low back pain. The needle is inserted from the back on the affected side to reach the epidural space to deliver steroid medication (green) to the inflamed nerve root.
Step 3: inject the medication
When the needle is correctly positioned, the anesthetic and corticosteroid medications are injected into the epidural space around the nerve roots. The needle is then re¬moved. Depending on your pain location, the procedure may be repeated for left and right sides. One or several spinal levels may be injected.
What happens after treatment?
Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the center. Rarely temporary leg weakness or numbness can occur; therefore someone should drive you home.
Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol). You may want to record your levels of pain during the next couple of weeks in a diary. You may notice a slight increase in pain, numbness, or weakness as the numbing medicine wears off and before the corticosteroid starts to take effect.
Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.
What are the risks?
With few risks, ESI is considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, and allergic reaction.
Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).
What are the results?
Many patients experience some pain relief benefits from ESI . For those who experience only mild pain relief, one to two more injections may be performed, usually in 4-6week intervals, to achieve full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with a physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.
If you have more questions, please contact Haven Orthopedics & Spine Institute (909) 372-0000
We provide the following treatments options, and more!
STEM CELL THERAPY
Stem Cell Therapy uses amnion allograft (tissue graft) to add natural growth factors to treat site-specific parts of the anatomy. It helps modulate inflammation, reduce scar tissue formation, and enhance healing. Growth factors are powerful agents that our bodies produce to signal cells to help the site heal. The therapy will also help your own cells regenerate the damaged tissue.
There have been 226 different growth factors, specialized cytokines and enzyme inhibitors identified in amnion allograft therapy. The amniotic membrane tissue is donated by healthy consenting mothers undergoing scheduled Cesarean sections during normal, healthy childbirth. Tissue donors are tested for infectious diseases, similar to blood donation. The amniotic membrane then undergoes a validated proprietary process to thoroughly cleanse and preserve the tissue.
PLATELET RICH PLASMA (PRP) THERAPY
Platelet Rich Plasma, or PRP, is blood plasma with concentrated platelets and multiple growth factors. The concentrated platelets found in PRP contain very large reservoirs of bioactive proteins, including growth factors and signaling proteins that initiate and accelerate tissue repair and regeneration.
These bioactive proteins initiate connective tissue healing in tissues such as meniscus (knee) and rotator cuff tissue, bone and articular cartilage regeneration and repair, promote the development of new blood vessels, and stimulate the wound healing process.