Epidural Steroid Injections
Frequently Asked Questions
An epidural steroid injection (ESI) is an outpatient procedure indicated to treat your condition. This procedure consists of injecting cortisone and saline into the space around your spinal canal called the epidural space.
The dura is the thin lining that contains the spinal fluid and nerves. The epidural space is the area or space between this fluid filled sac and the bones of the vertebrae. Our goal is to place the tip of the needle near the sac, but not into it. If the needle is placed in the fluid-filled sac (through the dura), we have performed a spinal tap.
The injection is usually performed in the lumbar area at the level of the waist or belt line. If difficulty is encountered in that area, we sometimes place the needle lower at the end of the spine near the tailbone.
The procedure is most easily, comfortably and accurately performed if a fluoroscope is used to visualize the needle placement. A fluoroscope is an x-ray machine that allows us to see motion while we place the needle. For this reason, we perform epidural injections at the hospital where a fluoroscope is available.
Cortisone is a potent anti-inflammatory drug. When injected, we hope that the anti-inflammatory effects of the drug will reduce the swelling and pain of the inflamed tissues and nerves that are causing your discomfort. Most patients experience some relief beginning within 24 hours following the injection. It can take 5 to 7 days to obtain relief. A few patients will get no relief at all. The duration of relief will vary depending on the underlying condition and its severity. The procedure can be repeated as frequently as weekly for three successive weeks. After that, we recommend waiting 3 to 4 months before repeating the injection or pursuing a different treatment plan.
The procedure is done using strict, sterile technique. This requires a surgical type of cleansing of the skin and the use of sterile gloves and equipment. You will be awake during the procedure, and we will talk to you and tell you what to expect throughout the procedure. You will feel a needle stick when “local” anesthesia is injected to numb the skin and deeper tissues. When the cortisone and saline are injected, you will feel a deep pressure sensation and perhaps experience some pain. This is usually of very short duration.
There are potential complications with this procedure. Occasionally, the dura is penetrated with the needle. This can lead to a headache that may last up to 24 hours. Infection is another potential complication, although quite rare. Bleeding around the area of the injection can also occur but is also very rare.
Strict precautions are taken to prevent complications and problems. If, however, the needle passes into the spinal fluid, you are advised to stay in bed and rest for 24 hours. This will usually prevent any further problems. If you appear to have any infected skin lesions near where the needle would be placed, the procedure will not be performed until the infection is cleared. Bleeding is best avoided by not using anti-coagulant medication or blood-thinning drugs, including aspirin or other anti-inflammatory pills used to treat arthritic conditions. If you have questions about this or anything else, ask your doctor before the procedure.
It is advisable to have someone accompany you to the facility, so that if necessary, they can drive you home. If no complications occur, you can continue with normal activity, including returning to work, immediately following the injection.
There will be three separate charges for this procedure:
- The doctor’s fee
- A charge by the hospital for use of the outpatient facilities
- A charge for the use of the fluoroscope
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If you have any questions or concerns, please feel free to contact our office at the Central Texas Spine Institute.