Epidural Steroid Injections ; Do They Work?

Epidural Steroid Injections ; Do They Work?

2

hi I'm Dr. John Shim and today I want to talk about lumbar epidural steroid injections. Many of you have had this recommendation already made by your doctors. So what really is an epidural injection? To make it very simple basically you take a small needle you place it through the skin and then the needle is placed right next to the nerves that come out of your lower back. I like to put the needle and what's called a transforaminal location. The needle was placed slightly outside the hole where the nerves come out of the spine called the foramen when you place that needle it has to be put in a very careful position the needle can't go too deep where it will cause the irritation of the nerve it has to go deep enough so the medicine will bathe the nerve. Now the medicine use is a steroid. Steroids decrease the inflammation. When you have a nerve pain at the transforaminal level or at the epidural space a lot of times is caused by a chemical spill caused by a disc herniation the steroid medications help mop up or decrease the inflammation caused by this chemical spill. That's why the epidural injections can and often do work. Understand that the epidural injections is a multi-step process: first the skin is cleansed then we use x-ray guidance to make sure we have the needle placed in the proper location for the nerve that's irritated. I use something called a transforaminal approach; that means the needle is placed through the skin through the muscles through the fascia and just place just to the outside of the facet joint and passing into the space called the foramen. In that foramen you have to be careful not to put the needle too deep because, you'll pierce the nerve. You also have to be careful not to place the needle into small blood vessels that surround the nerve because that can cause a different set of problems. Once the needle is placed that needle is aspirated, or drawn back to make sure it's not actually in the wrong location, then the steroid medication is delivered onto the nerve. With time, with the steroids the inflammation that nerve will decrease and there'll be less leg or back pain. The epidural injections is a very useful and at times very effective means to manage leg pain caused by nerve irritation. Understand however there are certain risks so if your doctor hasn't discussed them with you make sure number one you're off all blood thinners and off all anti-inflammatory agents. That small blood vessel that we talked about you don't want that to continue to bleed if you accidentally pierce it. Number two if you're diabetic steroid medications can cause a significant flare-up of your blood sugars and may actually cause you to have some sort of diabetic crisis. And number three understand that at times even though it's not the intention of the procedure you can have a flare-up of leg pain or back pain just by the procedure itself. In general I'd say about 85% of the time people feel better with the epidural steroid injection It doesn't work for everybody but when it works it definitely helps you get better faster. This is Dr. Shim talking about lumbar epidural steroid injections. I hope this information was useful to you. Thank you.

 

In our practice,  we use Epidural Steroid Injections for both treatment as well as diagnostic purposes.  The research for these injections have been significant, but the conclusions by the various authors have been very different.   There continues to be controversy on the efficacy of the treatments, including the side effects versus the results.

Traditionally,  epidural steroid injections have been seen as a reasonable treatment option for patients with back pain and sciatica. Based on research and experience,  we use epidural steroid injections when a patient has a sciatic, or nerve inflammatory complaint.

Epidural steroid injections benefit the patient by delivering corticosteroids to the areas of inflammation.  The steroids have a known anti-inflammatory effect and will decrease the swelling to the tissues upon contact.  In a very simplistic way,  by decreasing the inflammation,  the affected nerves in the spine will be less irritated and therefore cause less pain.

Some practitioners also inject a volume of saline associated with the steroids and theorize that the volume of saline also flushes the area of painful chemicals that also lead to the inflammation.

For diagnostic purposes,  if the epidural steroid injections give even temporary relief,  it usually confirms that there is an irritant to certain nerves.  Based on temporary improvement, surgeons may consider the patient an appropriate candidate for surgery, as many practitioners use the so called transforaminal technique to try to isolate the specific nerve that may be causing the irritation.

There are certainly risks to the procedure, such as increased blood sugar, possible bleeding or infection, possible nerve injury. They should always be done with x-ray guidance and any blood thinners or anti-inflammatories must be stopped at least 5 days before the injection.

 

Citations

  • Lewandrowski KU. Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection. Clin Neurol Neurosurg. 2018 Jul 24;173:38-45. PubMed PMID: 30075346

Submit a Comment

  1. Do you accept Wellcare essential. I have had 7 injections and blocks but my lower Siatica is horribly painful. I can find help

    1. I’m sorry David. We do not accept any Health Insurances. We work as concierge type practice. That said, if you are still having severe pain after 7 injections, it may be time to try something else. Steroids do have side effects and should be used sparingly.

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*

Disclosure Statement

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
Please note all articles, blogs and Q&A’s on this site are general information and are not to be used as medical advice for individuals. No specific diagnosis or treatment should be made based on this information. Only a physician can provide you with advice specific to your situation. Please followup with your physician if you would like to discuss your individual condition.

If you are having a medical emergency,  contact your Doctor immediately,  or go to the Emergency Room.
ShimSpine and ShimSpine.com is committed to honoring and respecting the privacy and anonymity of the individuals using its website(s) and/or services. The purpose of this Privacy Policy is to inform the individuals about the collection, processing and protection of information done by ShimSpine what information we collect, why we collect this information and how we use this information.

This Privacy Policy will be reviewed regularly to reflect the up-to-date practices of ShimSpine.