Epidural Steroid Injection

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Low Back Pain Relief

What is an epidural steroid injection?

An epidural steroid injection is a common procedure to treat spinal nerve irritation that is most often caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) may be irritated by a bulging intervertebral disc, disc contents ("ruptured disc") or bone spur, directly touching the spinal nerve.

Picture of a disc herniation compressing the spinal nerve root
Picture of a disc herniation compressing the spinal nerve root

An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.

What specialties of doctors administer epidural steroid injections?

Specialists who administer epidural steroid injections include anesthesiologists and pain-management specialists.

Quick GuideSciatica Symptoms, Causes, Treatments

Sciatica Symptoms, Causes, Treatments

Treatment of a Herniated Disc

Epidural

Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication (such as methylprednisolone or prednisone), without the need for surgical intervention.

How is an epidural steroid injection performed?

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: "Is that all?"

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of "durable"). The Greek word "epi" means "outside of." So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the locally inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

Epidural steroid injection with injection needle visible in the epidural 
space using a fluoroscope
Epidural steroid injection with injection needle visible in the epidural space using a fluoroscope

When are epidural steroid injections used?

Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy), such as from lumbar spinal stenosis, cervical spinal stenosis, herniated disc, and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy, which causes pain.

What complications or side effects may be associated with epidural steroid injections?

Complications of epidural steroid injections include elevation of blood sugar (glucose), insomnia, bleeding into the spinal canal, and rarely, bacterial or fungal infection in the spinal canal.

What is the recovery time for an epidural steroid injection?

Recovery from an epidural steroid injection is typically within hours of the injection. If anesthetic is administered with the steroid, there can be hours of residual numbness of the nerves that were anesthetized.

REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

Last Editorial Review: 9/2/2016

Reviewed on 9/2/2016
References
REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

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