Epidural Steroid Injections (Back Pain & Sciatica)

Epidural steroid injections are considered when persistent and severe pain is challenging to manage through other means. This type of pain typically originates from inflammation of spinal nerves, exacerbated by conditions that narrow the pathways through which these nerves travel.

Scenarios where an epidural steroid injection might be considered include:

• Intense Leg or Arm Pain: If inflamed spinal nerves are causing sharp pain down your legs or arms.

• Herniated Discs: When discs in the spine press on nearby nerves.

• Vertebral Misalignment: Commonly referred to as "slipped" vertebrae, where the bones of the spine move out of place and compress nerves.

• Joint Cysts and Bone Spurs: These growths can intrude into the space of the spinal canal, irritating the nerves.

• Ligament Thickening: Often due to spinal arthritis, thickened ligaments can reduce the space within the spine, compressing the nerves.

Indications for an epidural steroid injection include persistent pain that does not improve with medication or physical therapy, radiating pain along the affected nerve path, and significant reduction in mobility or quality of life due to pain. 

Epidural steroid injections are a viable treatment for a variety of chronic pain conditions that affect the spinal area. 

Conditions that typically respond well to this treatment include: 

• Herniated discs
• Spinal Stenosis
• Degenerative Disc Disease
• Sciatica
• Radiculopathy 

Preparation Before Epidural Steroid Injections

Preparing for an epidural steroid injection is a structured process aimed at ensuring your safety and maximising the effectiveness of the treatment.

• Full Disclosure: Communicate all health conditions and medications to your healthcare provider, including any over-the-counter drugs and supplements, as special considerations are necessary if you are pregnant or suspect you might be.

• Pre-procedure Guidelines: Your physician will instruct you on specific pre-procedure requirements, such as fasting, making medication adjustments, and the possibility of MRI or CT scans prior.

• Day of Procedure: Ensure you have someone to drive you home, particularly if you receive sedation.

What Happens in the Actual Epidural Steroid Injection Procedure

The procedure itself, which typically takes 30-45 minutes, involves several steps:

• Preparation: The target area on your back or neck will be cleaned with antiseptic soap and covered with a sterile drape.

• Anaesthesia: A local anaesthetic is applied to numb the area, which may initially cause a stinging sensation.

• Needle Insertion: Under X-ray guidance, the needle is carefully inserted into the epidural space. If you experience discomfort, an additional anaesthetic may be used.

• Medication Delivery: Once the needle is appropriately positioned, the steroid medication is infused to help reduce inflammation and pain.

• Completion: Following the injection, the site is cleaned, a bandage is applied, and you will rest briefly under observation.

You can leave the hospital with your arranged transportation once the medical team ensures that your vital signs are stable and you are feeling well enough to travel. The bandage can be removed the following morning at home.

After an epidural steroid injection, patients typically experience immediate numbness in the affected area due to the local anaesthetic, which may cause temporary heaviness or weakness for a few hours. Most side effects, such as minor soreness or bruising at the injection site, generally subside within a few days. Thereafter, improvement in pain and function can last for several months, and the procedure may be repeated if beneficial, as advised by your healthcare provider.

Post-procedure, it is advisable to avoid strenuous activities for the first 48 hours to allow the injection site to heal. If you do not experience pain relief or if side effects occur, consult your healthcare provider to assess the need for further evaluation or treatment adjustments. 

While epidural steroid injections are generally safe, they do carry potential risks and side effects. However, serious complications such as nerve injury, infection, bleeding, and allergic reactions to medication are rare. 

Some of the side effects which may require medical attention include:

• Dural Puncture

Other risks include:

• Bleeding at the injection site or within the epidural space
• Infection at the injection site or within the spine
• Nerve damage due to improper needle placement
• Allergic reactions to the medication used in the injection

Short-term side effects may include:

• Steroid flush
• Sleep disturbances and anxiety
• Menstrual changes
• Water retention