Epidural steroid injections
(ESIs) are a common treatment
option for many forms of low
back pain and leg pain. They
have been used for low back
problems since 1952 and are
still an integral part of the
non-surgical management of
sciatica and low back pain.
The goal of the injection is
pain relief; at times the
injection alone is sufficient
to provide relief, but
commonly an epidural steroid
injection is used in
combination with a
comprehensive rehabilitation
program to provide additional
benefit.
Most practitioners will agree
that, while the effects of the
injection tend to be temporary
- providing relief from pain
for one week up to one year -
an epidural can be very
beneficial for a patient
during an acute episode of
back and/or leg pain.
Importantly, an injection can
provide sufficient pain relief
to allow a patient to progress
with a rehabilitative
stretching and exercise
program. If the initial
injection is effective for a
patient, he or she may have up
to three in a one-year period.
Overview
Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, back pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy. Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.
Anatomy
The brain is covered by three membranes (dura, arachnoid, and pia), called the meninges that extend through the base of the skull and surround the entire spinal cord. The spinal cord travels down the entire length of the spinal column through the spinal canal. The epidural space is located between the dura and the interior surface of the spinal canal and contains veins, arteries, and fat. Epidural injection is the injection of medication into the epidural space.
Procedure
Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.
A mild sedative and a local anesthetic may be given prior to the procedure to relax the patient and numb the injection site. Medications, usually an anesthetic such as bupivacaine or a muscle relaxant, and a corticosteroid such as methylprednisolone, are injected directly into the epidural space. (The injection is commonly called a cortisone shot.)
Effectiveness
Approximately 30% to 70% of people who receive an epidural injection benefit from it. Some patients notice improvement within hours of the injection; others improve over a number of days; and others experience no improvement with the treatment. In some cases, two or three injections are given over weeks or months.
Complications
Complications resulting from an epidural injection are rare. Possible conditions that may develop following the procedure include infection (e.g., epidural abscess), bleeding into the epidural space, and headache caused by a cerebrospinal fluid leak. Approximately 2% of patients experience side effects from the corticosteroid, such as mild fluid retention.
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