What Is Epidural Steroid Injection?
Nerve roots leave the spinal canal through small openings between the vertebrae. When a herniated disc, bone spur or narrowed canal presses on a nerve root, the nerve becomes inflamed and can send pain, numbness or tingling down an arm or leg. An epidural steroid injection delivers a corticosteroid (a strong anti-inflammatory medicine), usually with a local anesthetic, close to the irritated nerve.
Dr. Baskin, a physiatrist board-certified in physical medicine and rehabilitation and in interventional pain management, most often uses a transforaminal approach in the lower back and neck. Transforaminal means the needle is guided to the opening where a specific nerve root exits, so the medicine reaches the nerve that is causing your symptoms. He uses fluoroscopy, a live X-ray, and a small amount of contrast dye to confirm the needle position before any medicine is given.
The goal is to reduce pain enough that you can move more comfortably and take part in physical therapy. An injection does not repair a disc or widen the spinal canal, but it can give the nerve time to settle.
Performed under live X-ray (fluoroscopy) guidance in our in-office procedure room.
Who Is a Candidate?
You may be a candidate if you have nerve pain from the spine that has not improved enough with rest, medication and physical therapy, and your exam and imaging point to a specific cause. Common reasons include:
- Sciatica, meaning pain radiating from the low back into the buttock and leg
- A herniated or bulging disc pressing on a nerve root
- Lumbar or cervical spinal stenosis, a narrowing of the spinal canal
- Neck pain that travels into the shoulder, arm or hand
An injection may not be right if you have an active infection, a bleeding disorder, poorly controlled diabetes, or an allergy to contrast dye. Tell us about blood thinners before your visit; some need to be paused with approval from the doctor who prescribes them.
What to Expect
Before scheduling, Dr. Baskin reviews your history, examines you and looks at your imaging. X-ray and MRI are available in our office if you need them.
On the day of the procedure you lie face down (or on your side for some neck injections). The skin is cleaned and numbed. Using live X-ray, Dr. Baskin guides a thin needle into position, confirms it with contrast dye and then injects the medicine. The injection itself usually takes several minutes, and the whole visit, including check-in and a short observation period, is typically under an hour. Please arrange a ride home.
Risks and Side Effects
Epidural steroid injections are common and generally well tolerated, but no procedure is free of risk. Possible side effects and risks include:
- Temporary soreness at the injection site or a short-term increase in pain
- Facial flushing, trouble sleeping, or mood changes for a few days
- Higher blood sugar for a few days in people with diabetes
- Headache, which can occur if the needle punctures the membrane that surrounds the spinal nerves
- Rare risks such as infection, bleeding or nerve injury
In 2014 the FDA added a warning that rare but serious problems, including loss of vision, stroke, paralysis and death, have been reported after steroid injections into the epidural space. Injectable steroids are not FDA-approved for epidural use, although these injections are widely performed. Dr. Baskin reviews these risks, including any that apply to injections in the neck, with you before the procedure.
Because steroids can affect bone and blood sugar over time, the number of injections in a year is usually limited.
Recovery
Most people return to normal light activity the next day. The numbing medicine can bring short relief right away, and the steroid typically starts working within a few days, sometimes up to two weeks. How long relief lasts varies widely, from a few weeks to several months.
Our physical therapists work in the same office and share your chart with Dr. Baskin, so therapy can begin once your pain settles. Strengthening and movement retraining are what help you keep the gains after the medicine wears off.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Medicare and most commercial PPO plans usually cover epidural steroid injections when medical necessity criteria are met, such as documented symptoms and a trial of conservative care. Some plans require prior authorization. HMO plans need a referral from your primary care physician on file before your visit. Our team verifies your benefits when you call, and co-pays, co-insurance and deductibles are due at the visit.
When to Talk to a Specialist
Call our office if back or neck pain travels into an arm or leg, lasts more than a few weeks, or keeps you from sleeping, working or walking.
Go to the emergency room or call 911 if you have loss of bladder or bowel control, numbness in the groin or inner thighs, or sudden severe weakness in a leg or arm. These can be signs of serious nerve compression.
