Epidural Steroid Injection

An epidural steroid injection is very similar to a regular cortisone injection. Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting.

Injectable cortisone is synthetically produced and has many different trade names (Celestone, Kenalog, etc.), but is a close derivative of your body's own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

An epidural steroid injection places this powerful anti-inflammatory medication directly around the spinal nerves. To administer the epidural steroid injection, your doctor will have you lie flat, face down, on an x-ray table. Using the x-ray to visualize the location of the tip of the needle, your doctor will guide the needle to an area very near to the spinal nerves, called the epidural space. Using the x-ray improves the chance the medication will be given in the proper location. The epidural steroid injection lasts about 15 minutes, and light sedation may be used if needed.

Epidural steroid injections may be given by many types of physicians, including anesthesiologists, orthopedic surgeons, neurologists, interventional radiologists, and others trained in this technique. Usually a series of injections, often three, each spaced a week apart, are given. With this schedule, many patients find relief of symptoms within a few weeks. Often this helps control the inflammatory process and may provide long-lasting relief.

Side-effects from epidural steroid injections are rare, but should be discussed. These include:

• Infection: Very unusual (less that 0.5%), and usually avoided by using a sterile technique.
• Bleeding: Also unusual, and avoided by not performing this procedure on patients with bleeding disorders or those on blood thinning medication.
• Dural Tears: Caused by piercing the sac around the spinal nerves with the needle. This usually results in a headache.
• Increased Blood Sugar: Diabetics must carefully monitor their blood sugar after this or any other steroid injection.

Other side-effects are possible, and should be discussed prior to injection with the doctor performing this procedure.