Doctor Knab, MD, Doctor Arora, MD, and Physicians Assistant Offer the Epidural Steroid Injection (ESI) Procedure and Treatment to Relieve Neck, Arm, Leg, Back Pain, and Sciatica.
An epidural steroid injection (ESI) is a commonly performed procedure that can help relieve neck, arm, back, and leg pain as a result of inflamed spinal nerves. Inflamed spinal nerves are often caused by leaky discs, disc herniation, bone spurs, thickening of the ligaments in the spine, joint cysts or even slipped vertebrae.
There are two ways to deliver epidural steroid injections:
• Interlaminar ESI. This method accesses the epidural space from the middle of the back under x-ray guidance. The needle is inserted between the two vertebrae directly through the numb skin overlying the ligaments and muscles. When the needle tip is in the correct place, the local anesthetic and steroid medication are injected to the epidural space. Medication is delivered to multiple nerve roots on both the right and left sides of the midline at the same time.
• Transforaminal ESI. This method accesses the epidural space from the left, or right or both sides of the midline of the back. It is indicated when pain is localized along the distribution of single nerve root or in patients who have undergone a previous spine surgery. The needle is placed under x-ray guidance to the side of the vertebra, just close to or in the exit opening for the nerve root. Use of a contrast dye indicates where the medication will flow when injected.
What to expect after ESI:
The ESI contains a mixture of local anesthetic and a steroid medication.
The local anesthetic may provide partial pain relief within 10 to 15 minutes after the completion of the procedure but may last for few hours only. Mild numbness or heaviness of an extremity can also be experienced but most patients are able to stand and walk out without assistance.
The steroid will usually start working within 24 to 72 hours. The pain relief and improvement in function may last for days or weeks or even several months after the single injection or a series of injections.
Although uncommon, some patients will experience an increase in their usual pain for few days following the procedure.
The steroids are generally very well tolerated, however, some patients may experience side effects, including flushing of the face, anxiety, difficulty in sleeping, changes in mood or menstrual cycle, or temporary increase in blood sugar and water retention. These side effects are usually mild and will often resolve within a few days.
Serious complications are rare when the procedure is performed by an experienced physician using fluoroscopic guidance but could include allergic reaction, bleeding, infection, nerve damage, or paralysis. Overall, ESIs are usually well tolerated and the majority of patients do well.
How much time do I need to take off work?
The procedure takes about 15 minutes. Following the injection, some patients need to be monitored for 15 to 20 minutes before being discharged to go home. Patients are usually instructed to take easy on the day of the epidural steroid injection. In most patients, normal activities may be resumed the following day.
How Frequently Can Epidural Steroid Injections be Performed?
In general, Epidural Steroid Injections are done in two-week intervals. It is considered safe to perform up to three epidural injections within a six-month period.