One treatment that is frequently recommended for patients with spine problems are epidural steroid injections (ESI’s). They are particularly effective for patients who have radiculopathy (nerve pain) and are thought of as ‘conservative care” though they are often done in surgery centers or small OR’s.
Properly administered using fluoroscopy (live x-ray), a corticosteroid (Dexamethasone) is injected around the affected nerve into your neck or low back at a particular level (location as determined by your symptoms and imaging). This medication is used to reduce the inflammation around the nerves thereby reducing your pain. If a short acting anesthetic agent is used (lidocaine) in the lumbar area, this is also diagnostic as the pain should be immediately diminished for an hour or so after injection. This will tell the physician 1) they have a well positioned injection and 2) the pain is being generated at this level.
As with any surgical procedure or injection, certain risks must be considered. Injury to nerve root(s) resulting in paralysis, excessive bleeding, weakness or infection are possible risks of this procedure. Although such complications are rare, you should feel free to discuss the question of risk with your doctor. There is also documentation that the administration of steroids can increase osteopenia and osteoporosis.
- It may take a few days before you begin to feel better after your spinal injections.
- There is the chance that you may experience some flushing or palpitations following the spinal injections. Diabetics may notice an elevation of blood sugar (glucose) levels. This tends to be a transient effect. These are not side effects or allergic reactions, but rather a normal action of the medication.
- While everyone’s pain levels and tolerances differ, the amount of relief you get from the spinal injections depends on your particular symptoms and condition. In some cases, multiple spinal injections may be required. You will get the maximal benefit of the spinal injection within the first 7 days. If the first two injections are ineffective, another treatment should be sought.
- You should be able to return to your usual activities 24 hours post injection.
- Sencan S, Ozcan-Eksi EE, Cil H, Tay B, Berven S, Burch S, Deviren V, Demir-Deviren S. The effect of transforaminal epidural steroid injections in patients with spondylolisthesis. J Back Musculoskelet Rehabil. 2016 Mar 27; PubMed PMID: 28372316
- Sharma AK, Vorobeychik Y, Wasserman R, Jameson J, Moradian M, Duszynski B, Kennedy DJ, Standards Division of the Spine Intervention Society.. The Effectiveness and Risks of Fluoroscopically Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data. Pain Med. 2017 Feb 1;18(2):239-251. PubMed PMID: 28204730