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Epidural Steroid Injections (ESI)
What is an Epidural Steroid Injection (ESI)?
An ESI is the injection of a steroid (synthetic cortisone) musculoskeletal medication around the outside of the disc.
What is the purpose of an ESI?
The steroid medication is a powerful anti-inflammatory medication. If any of the chemicals inside the disc leak out through a tear or herniation the tissues outside the disc can become inflamed. These tissues include the nerve roots and the ligaments.
What patients are candidates for an ESI?
Any patient whose symptoms or testing indicate their pain is coming from one or more of the discs of their back or neck.
How is the procedure performed?
The patient lies face down on the procedure table if the ESI injection is to the low or middle back, on their side if the injection is to the neck. X-ray equipment (fluoroscopy) is used. The site to be injected is numbed with local anesthetic (Novocain) and a needle is directed to the target area. Contrast (x-ray dye) is injected to be sure the needle is in the proper position, and then the medication is slowly injected. Often two injections are done at the same appointment to get medication above and below the painful disc, or if multiple discs are involved.
Will the procedure be painful?
There is a certain amount of discomfort involved with this procedure. Most of the pain occurs when the skin and underlying tissues are numbed. The smallest sized needle that will accomplish the procedure is always used. A pressure sensation is common when the medication is injected. Occasionally, the nerve root is accidentally touched, and you may feel a more sharp pain. This lasts only a few seconds and is gone as soon as the needle is moved. You may have sedation for this procedure, but many people do it under “local.”
What are the risks and side effects?
Complications for this procedure are low. Whenever a needle enters the skin, bleeding or infection can occur. If the bleeding presses on the spinal cord, surgery may be necessary. ESI’s in the neck have more risk because there is less room for any bleeding. Stroke has been a complication of injections in the neck if the medication gets into a major vein or artery and blockage occurs. Extreme care is taken to avoid this by not using steroid medicines that have crystals because it is the crystals that clog the artery producing the stroke. More serious, but extremely rare, risks include nerve injury, paralysis, weakness or death. These complications have never occurred in my practice.
Side effects from the steroid medication include flushing, insomnia, increase in heart rate, some swelling, a rise in blood sugar and occasionally blood pressure, These side effects are usually mild and temporary, but a rare patient may find the “steroid effect” quite unpleasant.
If you are diabetic or have unstable blood pressure, clearance from your primary care physician should be obtained before the procedure. At a minimum, you should monitor your blood pressure and or blood sugar carefully until you are sure they are back to your normal level.
You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.
The most serious side effects from intravenous sedation are sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose.
How long does it take for the procedure to work?
Usually patients start to feel better within a few days, but some patients report improvement being delayed up to several weeks.
What restrictions will I have on the day of the procedure?
If you have sedation, you will not be allowed to drive, operate machinery, or make legal decisions until the next day. You should not soak until the skin is healed. You may shower the same day. You should avoid any vigorous activity for several days.