An epidural steroid injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space. Show ESI is not the same as epidural anesthesia given just before childbirth or certain types of surgery. ESI is done in a hospital or outpatient clinic. The procedure is done in the following way:
Your doctor may recommend ESI if you have pain that spreads from the lower spine to the hips or down the leg. This pain is caused by pressure on a nerve as it leaves the spine, most often due to a bulging disk. ESI is used only when your pain has not improved with medicines, physical therapy, or other nonsurgical treatments. ESI is generally safe. Complications may include:
Talk to your doctor about your risk for complications. Having these injections too often may weaken the bones of your spine or nearby muscles. Receiving higher doses of the steroids in the injections may also cause these problems. Because of this, most doctors limit people to two or three injections per year. Your doctor will most likely have ordered x-rays, MRI, or CT scan of the back before this procedure. This helps your doctor determine the area to be treated. Tell your provider:
You may be told to temporarily stop taking blood thinners. This includes aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin, Jantoven), naproxen (Aleve, Naprosyn), and heparin. You may feel some discomfort in the area where the needle was inserted. This should last only a few hours. You may be told to take it easy for the rest of the day. Your pain may become worse for 2 to 3 days after the injection before it begins to improve. The steroid usually takes 2 to 3 days to work. If you receive medicines to make you sleepy during the procedure, you must arrange for someone to drive you home. ESI provides short-term pain relief in at least one half of the people who receive it. Symptoms may remain better for weeks to months, but rarely up to a year. The procedure does not cure the cause of your back pain. You will need to continue back exercises and other treatments. ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O’Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 50. Mayer EAK, Maddela R. Interventional nonoperative management of neck and back pain. In: Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 107. Narayan S, Dubin A. Nerve blocks: spine. In: Argoff CE, Dubin A, Pilitsis JG, eds. Pain Management Secrets. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 43. Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. How often can you get epidural injections for back pain?Epidural steroid injections are recommended to be administered up to three to six times per year. In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common.
What is the success rate of epidural steroid injections?In another study conducted for the Humana Press, only 38% of those treated found any relief whatsoever after administering cervical epidural steroid injections for their pain.
How painful is a lumbar epidural steroid injection?In general, a lumbar epidural steroid injection can be a bit uncomfortable, but it shouldn't be painful. You can ask your doctor for a mild sedative to relax you before the procedure. Your doctor will first inject a local anesthetic into the skin on your back to numb the area.
What is the next step if an epidural injection doesn't work?An alternative to ESIs, or an option to consider if injections are no longer providing relief, is the mild® Procedure. mild® stands for minimally invasive lumbar decompression. It's a short outpatient procedure that relieves pressure on the spine through an incision smaller than the size of a baby aspirin (5.1 mm).
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