EPIDURAL STEROID INJECTIONS
An epidural steroid injection is a pain procedure which delivers an anti-inflammatory medication (steroid) into the epidural space around the nerves in the spine to reduce inflammation contributing to a patient’s pain due to conditions such as a herniated disc, a pinched nerve, or stenosis.
Results are variable and are not guaranteed. However, it is a treatment option when a patient’s pain is not improving over time with other conservative treatment including medications, physical therapy and/or chiropractor care.
The injections are performed under fluoroscopic guidance (x-rays). Because they are considered advanced procedures, they will need to be approved by your insurance carrier.
In regards to the low back (lumbar spine), there are three different routes in which a steroid could be delivered to the epidural space, an injection from the side (transforaminal approach), an injection from the midline (interlaminar approach), or an injection from below (caudal approach). In regards to the neck (cervical spine) and midback (thoracic spine), the transforaminal or the interlaminar approach is used. The decision on what approach is utilized is based on a patient’s presentation, advanced imaging study (i.e. MRI or CT) findings, and results from previous injections.
Epidural steroid injections are safe interventions when done under x-ray guidance (fluoroscopy). Injection site soreness/discomfort can occur. Rare but serious risks include infection, bleeding, nerve damage, and/or a spinal fluid leak. A patient can also develop side effects from the medications used (steroid, anesthetic, or contrast). Steroids can cause temporary facial flushing, anxiety, trouble sleeping, irritability, increases in blood sugar and blood pressure.
PROCESS INVOLVING AN EPIDURAL STEROID INJECTION:
1. Discussion with medical provider if there is a medical indication for an epidural steroid injection.
2. If the patient wants to proceed, IBJI’s authorization team will seek insurance approval for the injection. Most private insurance companies require documentation for failed conservative treatment (medications and a formal physical therapy program). The patient does not need do anything.
3. Once your injection has been approved, Dr. Garala’s secretary will call you to schedule your injection; please review Pre-Procedure Information. Dr. Garala usually performs injections Monday and Thursday afternoons, and Friday mornings. The injection will be performed on the 3rd floor of the Glenview office. It is recommended you have a driver.
4. After you check in, you will be taken to the fluoroscopy suite (special x-ray room). You will be asked on lay on your stomach on the x-ray table. The injection site will be exposed. Your skin will be sterilely cleansed. The area will be numbed with an anesthetic. The spinal needle will then be introduced and guided to the targeted area, where a steroid solution will be injected.
6. After your injection, your injection site will be cleansed again and a bandaid will be applied. You can remove the bandaid the next day. If it naturally falls off before then, no need to replace it.
7. Go home or even back to work, but take it easy. There is nothing you will do that will impact the efficacy of your injection, but try to avoid strenuous activities that day. You can resume all your typical activities the next day.
8. It can be 1-3 days for a steroid to begin taking an effect; peak effect can take 1-2 weeks. Unless stated otherwise, Dr. Garala would like you to schedule a 2 week follow up appointment to assess your response and if any additional treatment is warranted.
A patient lays prone on a table. A fluoroscope is maneuvered over the area of interest to provide live x-rays to ensure appropriate placement of the injection needle.
Different views/angles are obtained with x-rays to advance the needle to the targeted area. Once reached, contrast dye is injected first to confirm the correct position of the needle before the steroid solution is administered.
A list of video animations explaining cervical and lumbar epidural steroid injections are listed below: