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Epidural Corticosteroid Injections

(Epidural steroid injections)

Procedure overview

In the simplest of terms, an epidural corticosteroid injection is a way to deliver anti-inflammatory pain medication quickly inside the body via a syringe.

Epidural Injection Illustration
Epidural Injection (Click to Enlarge)

The medication is delivered to the epidural area, which is a fat-filled area that covers the spinal cord and protects it and the surrounding nerves from damage.

Generally, the effect is temporary, but other times the benefits continue even after the steroids have lost their effectiveness.

Reasons for the procedure

If you are experiencing intense, intractable pain in your legs or arms from inflamed spinal nerves, then an epidural steroid injection might be a treatment that could give you relief. Often, this pain is caused by the narrowing of the passages through which nerves travel from the spine to your arms or legs. This narrowing can cause inflammation of the spinal nerves.

A number of conditions may contribute to this narrowing, and are considered potentially treatable with epidural steroid injection. However, the evidence shows that patients with pain resulting from herniated discs may benefit the most from this procedure.

When injected, the steroids have an anti-inflammatory effect that can provide pain relief, generally lasting from weeks to months when effective.

Risks of the procedure

An epidural corticosteroid injection is generally well tolerated, but you can experience side effects such as:

  • "Steroid flush," or flushing of the face and chest, accompanied by warmth and an increase in temperature for several days

  • Increase in blood sugar in patients with diabetes

  • Suppression of the body's ability to make its own corticosteroids when individuals are taking certain medications

  • Sleeping problems

  • Anxiety

  • Menstrual changes

  • Water retention

  • In rare instances, pain that actually increases for several days following the procedure

Serious complications are quite rare but can include:

  • Allergic reaction

  • Bleeding

  • Nerve damage

  • Infection

  • Paralysis

Before the procedure:

  • An epidural corticosteroid injection is generally an outpatient procedure. You will arrive at your doctor's office or hospital and may be asked to change into a surgical gown to make the injection process easier.

  • You may want to request mild sedation for the procedure, but most patients receive just local anesthetic.

  • If you have diabetes, an allergy to contrast dye, or certain other medical conditions, you'll want to discuss any concerns with your doctor before getting the procedure.

Based on your medical condition, your doctor may request other specific preparations.

During the procedure

An epidural corticosteroid injection is a fairly straightforward procedure:

  1. Your doctor will use an X-ray machine showing moving images on a screen to guide the needle as he or she makes the injection and ensures that the needle is in the correct location.

  2. In addition, contrast dye is injected at the site before the medication to ensure that the medication will be traveling precisely to where it needs to go in the epidural space.

  3. The doctor will inject the corticosteroid medication itself, often along with a local anesthetic to help with pain relief.

After the procedure

Once the procedure is done, you can return home. Usually, you'll be able to return to normal activities on the following day. The steroids usually begin working within one to three days, but in some cases, you might need up to a week to feel the benefits.

Many people obtain several months of improvement of pain and function from the injections. If the injection is partially effective, or if it is effective but the pain returns, it may be reasonable to repeat the procedure. If you experience any side effects, be sure to contact your health care provider.

If you don't experience pain relief, talk with your doctor. This may be a sign that the pain is coming from some place other than the spinal nerves.