An epidural steroid injection is a type of injection in whichcortisoneis delivered to the outermost section of the spinal column, called the epidural space. It is used to treat radiating nerve pain from the low back, middle back, or neck.
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Purpose and Techniques
While an epidural steroid injection is often used in isolation, it is most effective when combined with a comprehensive rehabilitation program to reduce the need for future injections. Epidural injections are only meant to provide short-term relief, often to delay spinal surgery, or to aid in recovery following spinal surgery.
Risks and Complications
Epidural steroid injections are relatively safe with a low risk of complications. One of the most common risks is the accidental puncture of the tissue surrounding the spinal cord called the dura mater.
If this happens, fluid can leak out and cause a spinal headache. As per its name, headache is the central symptom. The injury is typically treated with bed rest and/or a procedure known as a blood patch in which blood is injected over the hole to form a seal as it coagulates.
If the needle touches the spinal cord or nerve root, it can cause short-term neurologic injury manifesting with numbness or tingling in the extremities for hours or days. With the advent of X-ray-guided injections, the incidence of this has dropped dramatically.
Allergic reactionsare rare (in the region of 0.1 to 0.3 percent) but may require emergency intervention if you experience wheezing, shortness of breath, hives, facial swelling, rapid breathing, and an irregular heart rate. Infection is also uncommon.
How the Injection Is Performed
An epidural injection takes a bit more preparation and recovery time than a traditional injection given the delicacy of the procedure and the need for alocal anesthetic.
Pinched Nerve in Lower Back: What to Do and Avoid
Pre-Test
Generally speaking, you would be allowed to have a small meal several hours before the procedure and can continue taking your normal medications. The only exceptions would be anticoagulants (blood thinners) or anti-inflammatory drugs (like aspirin or ibuprofen) that can cause bleeding.Your healthcare provider will tell you when to stop these drugs.
Once you’ve arrived for your appointment, you will be asked to remove some or all of your clothing depending on where the shot is to be delivered. A hospital gown will be provided to change into.
Throughout the Test
After changing, you would be led to the imaging room where an intravenous (IV) line would be placed in one of your veins. Medication may be delivered to help you relax.
You would then be placed on the X-ray machine over a bolster to help open the spaces between the spine bones. The skin will be cleaned with an antibacterial swab and injected with a local anesthetic to numb the area.
Once fully numb, the healthcare provider will insert the needle through the skin toward the spine. A small amount of dye may be injected to verify the needle’s position on X-ray. Finally, the cortisone will be delivered into the epidural space mixed with a mild anesthetic.
Post-Test
Once completed, the needle and IV line would be removed and the puncture wounds bandaged. You would need to remain in the recovery room for around an hour. If your vital signs check out, a friend can drive you home. You would not be allowed to drive yourself.
On the other hand, seek emergency care if you experience any signs of infection or allergy, including high fever, chills, hives, breathing problems, nausea, vomiting, or severe pain.
A Word From Verywell
Epidural steroid injections are effective for providing short-term relief of severe acute or chronic radicular pain. They are used under very specific conditions and typically avoided if the pain can be treated with physical therapy or less invasive forms of therapy.
If you believe that you qualify for an epidural injection, meet with an orthopedic specialist who can advise you whether it is an appropriate option or if there are alternatives that may be just as effective or longer-lasting.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Epidural injections for back pain. US National Library of Medicine. April 2019.Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA.Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.Clin Orthop Relat Res. 2015;473(6):1940-56. doi:10.1007/s11999-014-3490-4Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV.Safety of Epidural Corticosteroid Injections.Drugs R D. 2016;16(1):19-34. doi:10.1007/s40268-015-0119-3Lee GY, Lee JW, Yeom JS, Kim KJ, Shin HI, Kang HS.The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study.Korean J Radiol. 2018;19(2):301-310. doi:10.3348/kjr.2018.19.2.301Epidural Corticosteroid Injections. Johns Hopkins Medicine.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Epidural injections for back pain. US National Library of Medicine. April 2019.Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA.Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.Clin Orthop Relat Res. 2015;473(6):1940-56. doi:10.1007/s11999-014-3490-4Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV.Safety of Epidural Corticosteroid Injections.Drugs R D. 2016;16(1):19-34. doi:10.1007/s40268-015-0119-3Lee GY, Lee JW, Yeom JS, Kim KJ, Shin HI, Kang HS.The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study.Korean J Radiol. 2018;19(2):301-310. doi:10.3348/kjr.2018.19.2.301Epidural Corticosteroid Injections. Johns Hopkins Medicine.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Epidural injections for back pain. US National Library of Medicine. April 2019.Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA.Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.Clin Orthop Relat Res. 2015;473(6):1940-56. doi:10.1007/s11999-014-3490-4Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV.Safety of Epidural Corticosteroid Injections.Drugs R D. 2016;16(1):19-34. doi:10.1007/s40268-015-0119-3Lee GY, Lee JW, Yeom JS, Kim KJ, Shin HI, Kang HS.The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study.Korean J Radiol. 2018;19(2):301-310. doi:10.3348/kjr.2018.19.2.301Epidural Corticosteroid Injections. Johns Hopkins Medicine.
Epidural injections for back pain. US National Library of Medicine. April 2019.
Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA.Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.Clin Orthop Relat Res. 2015;473(6):1940-56. doi:10.1007/s11999-014-3490-4
Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV.Safety of Epidural Corticosteroid Injections.Drugs R D. 2016;16(1):19-34. doi:10.1007/s40268-015-0119-3
Lee GY, Lee JW, Yeom JS, Kim KJ, Shin HI, Kang HS.The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study.Korean J Radiol. 2018;19(2):301-310. doi:10.3348/kjr.2018.19.2.301
Epidural Corticosteroid Injections. Johns Hopkins Medicine.
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