Epidural Steroid Injections: Say Goodbye to Pain!

Are you suffering from back pain, leg pain, or arm pain? If yes, then you’re not alone. These types of pain can significantly affect the quality of life and make even the simplest tasks seem impossible. Fortunately, there are non-surgical treatment options available that can help relieve the pain and improve mobility. One such option is epidural steroid injections, which are a commonly used procedure that involves the injection of a steroid medication into the epidural space of the spinal column. Let’s learn more about epidural steroid injections, their uses, benefits, risks, and possible side effects.

What is an epidural steroid injection?

An epidural steroid injection is a medical procedure designed to alleviate pain in the back, legs, or arms. It involves the administration of a steroid medication into the epidural space surrounding the spinal cord and its existing nerves. This injection is carefully guided by an X-ray machine, known as fluoroscopic guidance, to ensure precise needle placement and accurate delivery of the medication.

Why are epidural steroid injections used?

Epidural steroid injections are commonly employed to address various conditions that lead to debilitating pain. These conditions may include herniated discs, spinal stenosis, and radiculopathy. By targeting the affected area, these injections work to reduce inflammation, ultimately relieving pain and enhancing mobility. Additionally, epidural steroid injections can be used for pain management following spinal surgery, aiding in the recovery process.

With the expertise of the doctor and the assistance of advanced technology, epidural steroid injections offer tailored solutions for pain relief. By specifically targeting the source of pain, individuals can regain their quality of life through a personalised approach to pain management.

Did you know that 73% of patients with spinal issues experience lower back pain?

How are epidural steroid injections administered?

These are performed on a daycare basis. The procedure typically takes 15 to 30 minutes. The patient lies on their stomach, and the injection site is cleaned with an antiseptic solution. Local anaesthesia is then used to numb the skin and underlying tissues. A needle is inserted into the epidural space under fluoroscopic guidance, and a steroid medication is injected into the area. The medication is usually a combination of a corticosteroid and a local anaesthetic. The corticosteroid helps to reduce inflammation and relieve pain, while the local anaesthetic provides immediate pain relief. The amount of medication injected depends on the patient’s condition and the location of the injection.

Once the medication is injected, the needle is removed, and a small bandage is placed over the injected site. The patient is usually observed for a short period of time to ensure that there are no immediate complications or adverse reactions.

Types of epidural steroid injections

There are several types of epidural steroid injections that are used based on the specific needs of the patient. These include interlaminar, transforaminal, and caudal injections.

• Interlaminar epidural steroid injections:
  These involve injecting the steroid medication into the epidural space through the back of the spine. This method is commonly employed to address pain in the neck, upper back, or lower back. The needle is carefully inserted between the laminae of the vertebrae, allowing the medication to be delivered to the targeted epidural space.
• Transforaminal epidural steroid injections:
  These, on the other hand, entail injecting the steroid medication into the epidural space through the side of the spine. It is often used to alleviate pain in the neck, upper back, or lower back. The needle is inserted through the neural foramen, the opening between the vertebrae where the nerve root exits the spinal column. The medication is then administered into the epidural space, targeting the affected area.
• Caudal epidural steroid injections:
  These involve injecting the steroid medication into the epidural space through the sacral hiatus, which is the opening at the base of the sacrum. This type of injection is typically used to alleviate pain in the lower back or legs. The needle is inserted into the sacral canal through the sacral hiatus, allowing the medication to be directed into the epidural space for effective relief.

These different types of epidural steroid injections provide doctors with versatile options to address specific areas of pain and offer personalised treatment approaches for patients experiencing discomfort.

Benefits of epidural steroid injections

Epidural steroid injections can provide significant relief from pain caused by conditions such as herniated discs, spinal stenosis, and radiculopathy. The benefits include:

• Non-Surgical Treatment Alternative:
  Epidural steroid injections provide a non-surgical approach to pain management, making them an appealing option for individuals who are not suitable candidates for surgery or prefer to explore non-invasive alternatives.

• Pain Relief:
  The primary advantage of epidural steroid injections lies in their ability to alleviate pain. By targeting and reducing inflammation in the affected area, these injections can effectively relieve pain and enhance mobility.

• Enhanced Quality of Life:
  Epidural steroid injections have the potential to greatly improve patients’ overall quality of life by diminishing pain and enhancing mobility. This newfound freedom allows individuals to engage in activities that were previously hindered by their condition, thereby enriching their daily experiences.

Potential risks and side effects of epidural steroid injections

While epidural steroid injections (ESIs) are generally considered safe, it is important to acknowledge the potential risks associated with any medical procedure. Here are some risks to be aware of:

• Infection:
  As with any injection, there is a slight risk of infection. To mitigate this risk, the injection site is meticulously cleaned with an antiseptic solution, and the procedure is performed using sterile techniques.
• Bleeding:
  Bleeding is a potential risk associated with injections. To minimise the risk, it is crucial for patients to inform their doctor about any blood-thinning medications they may be taking.
• Nerve Damage:
  There is a small risk of nerve damage related to the injection process. To minimise this risk, it is imperative that epidural steroid injections be administered by qualified and experienced medical professionals who possess the necessary expertise.
• Dural Puncture:
  In rare instances, there is a risk of dural puncture, where the needle inadvertently punctures the outermost layer of the spinal cord called the dura mater. This may result in a headache that can persist for several days.
• Allergic Reaction:
  Although rare, there is a possibility of experiencing an allergic reaction to the medication used in epidural steroid injections. Patients should inform their doctor if they have a history of allergic reactions to any medications.

Some patients may experience side effects after an epidural steroid injection. The most common epidural steroid injections side effects are temporary and include:

• Headache
• Nausea
• Dizziness
• Facial flushing
• Insomnia
• Mood changes

The risks and side effects of epidural steroid injections are generally low, and the benefits outweigh the risks in many cases. However, one must consult the doctor about individual risks and benefits before undergoing any medical procedure.

Are there any alternatives to epidural steroid injections?

While epidural steroid injections (ESIs) have proven to be effective in pain management, it is essential to be aware of alternative treatment options that may be considered. Epidural steroid injection alternatives include:

• Physical Therapy:
  Physical therapy can be highly beneficial for reducing pain and enhancing mobility. A skilled physical therapist can design a tailored exercise programme that focuses on strengthening the muscles supporting the spine and targets the specific condition at hand.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
  NSAIDs, such as ibuprofen or naproxen, are medications that can effectively reduce inflammation and alleviate pain. However, it is important to note that these medications may not be suitable for all patients, particularly those with a history of stomach ulcers, kidney problems, or heart disease.

• Nerve Blocks:
  Nerve blocks involve the administration of a local anaesthetic around the affected nerve, providing temporary pain relief. While nerve blocks may not offer long-term relief, they can be effective in managing acute pain for a limited duration.
• Surgery:
  In cases where other treatments have proven ineffective in alleviating pain, surgery may be considered. Surgical intervention aims to address the underlying cause, such as the removal of herniated discs or decompressing nerves within the spinal cord.
• Alternative Therapies:
  Certain alternative therapies, including acupuncture or chiropractic treatment, may be considered for specific individuals. However, it is important to note that the scientific evidence supporting their effectiveness in treating spinal conditions is currently limited.

Lastly, epidural steroid injections provide a secure and successful non-surgical treatment alternative for various spinal conditions causing pain. It is important to acknowledge that, while epidural steroid injections are generally considered safe, there are potential risks to be aware of. Patients should be informed about the possible side effects and complications associated with the procedure. Additionally, it is crucial for individuals to engage in open and transparent discussions with their doctor regarding alternative treatment options in order to determine the most suitable course of action for their specific condition. Through collaborative decision-making and a personalised treatment plan, patients can effectively manage their spinal condition and experience an enhanced quality of life.

References:

• What to know about an epidural steroid injection
  https://www.medicalnewstoday.com/articles/epidural-steroid-injection
• Epidural
  https://my.clevelandclinic.org/health/treatments/21896-epidural 
• Lumbar Epidural Steroid Injections
  https://my.clevelandclinic.org/health/treatment
• 73% Of Patients With Spine Problems Have Lower Back Pain, Here’s Everything You Need To Know
  https://www.indiatimes.com/health/healthyliving/73-of-patients

About Author –

Dr. Srinivas Botla,Senior Consultant Neurosurgeon, Yashoda Hospitals – Hyderabad
MS, MCh (Neuro), FSFN