FAQ’s on Epidural Steroid Injection (ESI) in Philadelphia

An epidural steroid injection (ESI) is an outpatient procedure used to treat or diagnose a problem related to the back and spine. With this outpatient procedure, the doctor injections a steroid into the epidural space, which is the small space surrounding the dura mater (membrane that covers the spinal cord).

What medical conditions are treated with the ESI?

The epidural steroid injection is used to treat a variety of back and spine disorders. These include:

  • Herniated disc
  • Spondylolysis
  • Spinal stenosis
  • Degenerative disc disease
  • Bulging disc

What are the benefits of epidural steroid injections?

The corticosteroid is used to reduce inflammation of the spinal nerve root, relieve pain in the arms and legs, and to deliver medication directly to the affected area. In addition, ESI is used to accurately diagnose certain spinal conditions by deciding which nerves are involved with the condition.

What can I expect before the ESI procedure?

Before scheduling the procedure, the doctor may have you hold blood-thinning medicine for several days. Be sure to discuss your medications with the doctor in detail. When you arrive at the medical facility, the nurse will go over the risks and benefits of the procedure, and have you sign a consent form. Be sure to arrange to have someone drive you home.

What happens during the epidural steroid injection procedure?

The doctor will position the patient face down on the table, and injection numbing medicine for the skin and deep tissues. Once numb, x-ray guidance is used to insert the needle into the epidural space. Once in position, contrast dye is then injected to assure placement. The total procedure takes around 15 minutes.

What happens after the ESI procedure?

After the procedure, a nurse will observe the patient for around 20 minutes. Temporary weakness of the arms and/or legs is expected due to the anesthetic. After the procedure, patients cannot drive themselves home and must rest for the remainder of the day. Return to usual activities is encouraged as only tolerated.

Does the epidural steroid injection work?

Studies show that many patients have a decrease in arm/leg pain following the ESI procedure. The effects usually last between 6 and 12 weeks. Patients report that ESI has an 85-90% success rate. Studies show this is a safe, effective alternative to acute low back pain.

What medications are used in the ESI procedure?

The epidural steroid injection involve injecting a long-acting corticosteroid, such as triamcinolone or betamethasone. The doctor may also inject an anesthetic, such as lidocaine or bupivacaine. During the procedure, a sedative may be given to make the experience more tolerable.

Who is a candidate for the ESI procedure?

Patients who benefit from the epidural steroid injection include anyone with pain associated with the spine. Spine disorders cause serious nerve inflammation, and this alleviates and decreases pain. However, you cannot have an ESI if you have an active infection, suffer from a bleeding disorder, or are pregnant.

What are the complications and risks of the ESI?

While risks are rare, they do occur. Complications include nerve damage, dural puncture, bleeding, allergic reaction, and infection. Corticosteroids have many side effects, such as swelling, weight gain, insomnia, flushing, elevated blood sugar, and mood swings.

Resources

Ackerman WE & Ahmad M (2007). The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesthesia Analogs, 104(5):1217–22.

Lutz GE, VAd VB, & Wisneski RJ (1998). Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Archives of Physical Medicine Rehabilitation, 79,1362-1366.

Weinstein SM & Herring SA (2003) NASS. Lumbar epidural steroid injections. Spine Jounral, 3(3 Suppl):37S-44S.