Your Guide to Epidural Steroid Injections (ESIs)

An epidural steroid injection (ESI) involves administering a powerful anti-inflammatory agent, known as a corticosteroid, into the epidural space. Specifically, a corticosteroid is a manufactured medication that mimics the function of cortisol.

You may be asking… But, isn’t cortisol (aka, the “stress” hormone) something that we’re supposed to avoid?

In this instance, the answer is not exactly. 

Corticosteroids reduce inflammation by dampening your body’s immune system response. Although a well-functioning immune system is essential for healing, your body can actually over-respond to a perceived threat or insult, such as an injury. When this occurs, the inflammation that results can, unfortunately, cause more harm than good.

Remember, that mild inflammation serves a purpose. Think of it as evidence that your body is working overtime to heal itself. But, chronic inflammation signals a problem. It can result in tissue damage that counteracts the body’s attempts to heal itself.

When used appropriately, epidural steroid injections give the body a much-needed break from pain and accelerate healing. But, timing is key. Given this, you want to enlist the guidance of a pain management expert who truly knows this intervention inside and out. For best results, contact our orthopedic experts at the Injury Care Center and embark on your relief journey today!

Ideal Candidates for Epidural Steroid Injections (ESIs)

An Epidural Steroid Injection (ESI) works best for patients who suffer from chronic nerve pain. A variety of orthopedic conditions can lead to nerve compression. Some of the top culprits include:

  • Degenerative Disc Disease: Disc degeneration occurs when the spongy discs that sit between your vertebrae begin to break down from aging or overuse. When these discs collapse, bone-on-bone contact can occur, pinching the nerves that radiate between these adjacent vertebrae.
  • Herniated Discs: A herniated disc occurs when an intervertebral disc ruptures, releasing its internal contents into the disc space. This gel-like material reduces the real estate typically allotted for nerves, leading to neurological symptoms of discomfort.
  • Sciatica: Your sciatic nerve, i.e. the longest nerve in your body, extends from your lower back down to your toes. When this nerve becomes pinched, the sufferer experiences searing pain from their buttocks, down the backside of either leg, and into his/her feet and toes.
  • Spinal Stenosis: Stenosis is a widely used medical term that means narrowing. Spinal stenosis, therefore, occurs when key passageways that permit the exit of nerves from the spinal cord become constricted. With less room for the nerves to exit, they can suffer dysfunction, generating symptoms of pain and incapacity.
  • Spondylolisthesis: Also referred to as a slipped vertebra, spondylolisthesis occurs when a vertebra slides forward over the vertebra beneath it. As the spine shifts out of alignment, the vertebrae can impinge upon adjacent nerves.
  • Arthritis: Arthritis refers to inflammation of the arthroses (or movable joints). It results in a number of adverse effects, including the thickening of ligaments and the growth of bone spurs. In particular, bone spurs are tiny protrusions that develop in response to overuse and can compress nerves.

 

How is an Epidural Steroid Injection (ESI) Performed?

An epidural steroid injection involves delivering a corticosteroid medication directly to the source of a patient’s pain. In this instance, that means injecting the medication into the epidural space, a fat-filled region that cushions the spinal cord and its nerve roots.

Typically, your doctor will perform this minimally invasive intervention in an outpatient facility. Before administering the ESI, your doctor will use a local anesthetic to desensitize the area. If you are feeling anxious about the procedure, inform your doctor. Some physicians may prescribe a mild sedative, such as Valium, to counteract your nerves.

During the procedure, you will be awake to communicate with your doctor. Next, using x-ray fluoroscopy to visualize the bones, your doctor will achieve proper needle placement to deliver the medication.

There are multiple ways in which your doctor can approach your spine. Depending on your condition, the following approaches may be employed:

  • Transforaminal: Foramina are passageways through which the spinal nerves radiate outward to the body. A transforaminal approach, therefore, involves passing the needle through the foramen to deliver medication directly to the nerve roots.
  • Interlaminar: The lamina is the bony sheath that covers the backside of your spinal cord. An interlaminar approach delivers medication near the posterior spine, which may be more appropriate for conditions that involve diffuse inflammation, such as arthritis.
  • Caudal: Caudal means tailbone and, in this instance, refers to the lowest point on the epidural space. This approach is most appropriate for conditions that affect the lumbar spine and sacrum, such as sciatica.

Before administering the medication, your doctor will inject a contrast dye into the target region. Doing so ensures that the medication will reach the correct tissues. Then, the steroid itself is deposited into the epidural space. In total, the procedure should only last for roughly 15-45 minutes.

Recovering From an Epidural Steroid Injection (ESI)

Following a brief period of observation, you should be able to return home. Because some patients experience mild side effects from ESIs, you will likely be required to appoint a driver. Common side effects following the injection may include:

  • Nausea
  • Dizziness
  • Facial flushing
  • Water retention
  • Anxiety
  • Headache

 
Within 24 hours, however, the side effects should subside, allowing you to return to your daily routine. If you experience any of the following serious side effects in the days following your procedure, contact your doctor immediately:

  • Difficulty breathing or swelling of the throat/tongue (indicating a possible allergic reaction)
  • A high-grade fever (signaling the possibility of infection)
  • Migraine headaches that worsen when upright
  • Sudden weakness in the lower extremities or incontinence
  • Low blood pressure or a heart rate less than 60 beats per minute (bpm)

 
However, the likelihood of experiencing serious complications with an ESI is exceedingly rare. In general, you can expect to enjoy pain relief that lasts for up to an entire year.

Advantages of Choosing Epidural Steroid Injections

Epidural steroid injections boast numerous benefits when administered to a well-vetted candidate. Like many other minimally invasive procedures, you can expect to enjoy the following benefits unless complications arise:

  • Outpatient or same-day treatment
  • No incisions, scarring, or bleeding
  • Less postoperative pain
  • Fewer complications
  • Speedier recovery times
  • Enhanced accuracy (thanks to the use of fluoroscopic guidance and contrast dye injection)

 
Unique to this particular procedure, you may also notice the following perks:

  • Nearly instantaneous pain relief that lasts up to a year in duration
  • Less need to rely on potentially habit-forming medications like opioids
  • Increased tolerance for therapeutic interventions, like physical or occupational therapy
  • May obviate the immediate need for surgical intervention, particularly if the body can heal more effectively during this time of reduced pain

 

Several Important Caveats About Epidural Steroid Injections…

Epidural steroid injections aren’t for everyone. Truth be told, certain patients should avoid this type of intervention altogether. Contraindications to ESIs include the following conditions/situations:

  • History of a previous allergic reaction to a corticosteroid or contrast dye
  • Known bacterial infection near the site of injection or diffusely spread throughout the body
  • Pregnant women (unless fluoroscopy is omitted)
  • Patients with diabetes mellitus, bleeding disorders, or certain heart problems

 
As always, provide a detailed account of your medical history to your doctor before taking any new medication or undergoing a procedure.

And, remember: ESIs work best when combined with a multimodal approach to treatment that involves other conservative interventions, such as chiropractic care. In fact, the primary purpose of an ESI is to enable a patient to participate in additional treatments, such as physical therapy, that would otherwise be too painful. It is these other interventions in conjunction with the ESIs that really accelerate healing in patients with inflammatory conditions.

Your Healing Journey Begins NOW

Ready to discover if you’d make a suitable candidate for epidural steroid injections? Contact one of our dedicated patient advocates at the Injury Care Center of Philadelphia today.

Our pain management specialists are skilled in tried-and-true pain interventions, such as ESIs, facet blocks, trigger point injections, and more. In addition, our pain management physicians collaborate with industry-leading experts in physical and occupational therapy, interventional massage, and chiropractic manipulation to optimize your outcomes. Using a combination of medication management and nonsurgical treatments, we will design a multi-modal treatment plan that resolves your pain and restores your quality of life.

With ESIs, timing is key. Don’t miss your window – Contact our injury care experts today!