An epidural steroid injection is a procedure where steroids and possibly some long-acting numbing medications are placed around and outside the spinal nerve roots or spinal cord. The purpose is to place medications that reduce inflammation of the nerve roots and surrounding structures to relieve pain.
Steroids work to reduce inflammation by altering the creation of proteins. Steroids can take more than a day to start to work and can exert their action over weeks and potentially months. Steroids work on a variety of structures but specifically may reduce nerve root inflammation and swelling.
If a nerve root is in a tight spot, reducing the nerve root’s swelling and thus its size can make it where the nerve root no longer is compressed. This can lead to symptom relief either temporarily or long-term, depending on if the nerve root is re-irritated and swelling returns.
Dr. Birinyi likes to place both a steroid and a long-acting numbing medication together around the neural structures so that a patient can have instant relief until the effects of the steroid start.
The key to an epidural steroid injection is that the neurosurgeon places the medication at the site of its action where it is most needed. An injection of steroids into the muscle of the buttock or arm will go throughout the entire body and will work in areas where it is not needed.
Instead, an epidural steroid injection focuses the medication effects in one particular spot. They also can be very beneficial if only temporary relief is achieved as these injections are diagnostic in nature and allow the physician to isolate symptoms to a precise location so that further treatments can be done.
Oral medications can have systemic side effects like drowsiness, but epidural steroid injections do not cause the drowsiness associated with narcotic pain medications.
Epidural steroid injections can serve a diagnostic and therapeutic purpose. A diagnostic purpose is to help pinpoint where symptoms are occurring so that other therapies can be directed to the same location. A therapeutic purpose is to treat a patient by providing pain relief and comfort. Sometimes, both goals are achievable.
Diagnostic epidural steroid injections are helpful when it is not clear what nerve roots are involved with a particular pain, and these can be key to the complete neurosurgical assessment of a patient. Sometimes, patients only need a therapeutic injection in order to calm pain as the body attempts to heal itself, which it may do eventually.
For chronic pain management, epidural steroid injections can be used on a regular basis to temporize symptoms, sometimes avoiding the need for a large or risky surgery. Pain that radiates along a particular pattern in the upper or lower extremities is particularly well-suited to be treated, at least initially, by epidural steroid injections.
Performing a thorough physical examination, meticulously analyzing imaging, and using the knowledge and skill set of a neurosurgeon is key to determining where a patient would benefit most from an epidural steroid injection.
Doing this allows the neurosurgeon to tailor a treatment plan to an individual and his associated symptoms and conditions.
Epidural steroid injections often are done in a procedure or operating room. This is due to the need for sterility, x-ray imaging, and, often, the desire for sedation.
While sedation is not necessary for post-epidural steroid injections, many patients prefer to have the procedure done under sedation to reduce pain, and patients often have their anxieties alleviated by being comfortable and not remembering the procedure. It is important for a patient to discuss his needs and preferences regarding sedation with his doctor. With or without sedation, a spinal injection procedure begins with a patient being taken to the procedure room and placed on the procedure table.
It is important that patients remain absolutely still once positioned to allow for the safest possible procedure. At this point, sedation can be started/continued through an IV.
After confirming the procedure and area of injection, the skin is cleaned and numbed before a needle is inserted into the skin and directed to the site of the injection. The medication is injected once the needle has been confirmed to be in the correct location using fluoroscopy (x-ray) and contrast dye. The needle is removed, and patients are taken to the recovery area. This process typically takes under ten to fifteen minutes, depending on the complexity of the procedure and patient and the neurosurgical techniques utilized.
Following the injection, Dr. Birinyi likes his patients to perform their normal tasks and activities. This is the best measure of the effectiveness of the epidural steroid injection and is critical if the injection is done for diagnostic purposes.
Patients are encouraged to keep a diary of their symptoms and symptom relief following the procedure. Of note, Dr. Birinyi prefers to do many of his own ordered epidural steroid injections as he finds that he can learn about a patient and his spine by doing the procedure, which potentially prepares Dr. Birinyi to do a larger procedure, if needed, down the line.
With epidural steroids and spinal injections, side effects can include a feeling of jitteriness and energy, along with difficulty sleeping. These are due to the effects of steroid administration, which often are minor and will diminish within a few days of steroid administration.
In addition, there can be some injection site pain, which is typically mild since the numbing medication is often injected along with the steroid.
Occasionally, there can be a spinal fluid leak due to a puncture of the thecal sac, which is a structure that contains the spinal fluid. This can occur with an interlaminar (central) injection but would not be expected with a transforaminal injection.
If there is a spinal fluid leak, it typically is not a big concern. Headaches may occur, which should be temporary in nature and can be relieved by lying flat, drinking fluids, and taking caffeine. If a spinal fluid leak occurs and headaches do not resolve with these measures within two or three days, further interventions may be necessary.
Other potential complications would be infection, nerve root injury or irritation, and allergic reactions to the medications. Using a sterile environment and following proper patient safety protocols make serious complications from spinal injections extremely rare, and minor side effects are generally well-tolerated.
Epidural steroid injections may cause no effect, complete relief of symptoms, or cause any result between. The ability of the injection to help is determined by the technique of the person performing the injection, the medications used, and the pathology causing pain.
Steroids typically start to exert their effect a day or two after they are administered and may last for weeks. Typically, if symptom relief is achieved beyond several weeks, it is likely that the underlying problem has been calmed with no additional aggravation or flareups of the problem.
Sometimes, a steroid injection is not expected to provide long-term relief, but even temporary relief provides diagnostic utility, meaning that it provides further evidence and isolation of the problem. This can direct more permanent treatments like decompression or fusion surgery.
If some relief is achieved from an epidural steroid injection, the patient and neurosurgeon may choose to repeat these on a regular basis as part of a long-term strategy or as part of a strategy to relieve pain until surgery can be performed.
In any case, no more than three or four steroid injections typically should be performed in a twelve-month period. In summary, the success rate for epidural steroid injections is quite variable, but they are a low-risk treatment option with a potentially significant benefit that should be considered.
There are several myths and misconceptions regarding epidural steroid injections.
Firstly, many different types and techniques are used. There are many different locations in which the medication can be injected, and these can either create a diffuse pattern of steroid administration and symptom relief or can be directed with a large dose of medication in one particular spot. This means that all epidural steroid injections are not the same.
It is important to talk to your physician to understand which injection techniques and medications will be used and what symptoms these are expected to treat. Steroids work by calming inflammation and tend to work better for nerve irritation and less so for arthritic joint pain.
Secondly, while epidural steroid injections can have side effects, these are typically very minimal, with steroids being fairly safe. People with diabetes should be careful to monitor their blood glucose when receiving steroid injections, as steroids spike blood glucose temporarily.
Other medications, along with smaller steroid doses, can be used to avoid complications in severe diabetics. Also, some patients fear the pain from an epidural steroid injection. While the pain is quite minimal and numbing medications are used, sedation can be helpful to alleviate any fears and anxiety and can make a patient not remember undergoing an injection.
Thirdly, another pain management myth is that if steroid injections periodically provide relief, a patient does not need surgery. Unfortunately, there are some conditions that cause damage to the spinal cord and nerve roots permanently, and while pain can be reduced with epidural steroid injections, the more serious issues may need to be addressed surgically.
If you are a patient receiving frequent epidural steroid injections, it would be reasonable for you to consult with a neurosurgeon to see if there is a more worrisome underlying condition or if a simple neurosurgical procedure can provide a permanent solution for your problems.
Dr. Birinyi has observed numerous patient experiences and pain relief stories involving epidural steroid injections. Commonly, patients will come to Dr. Birinyi after having been recommended for a large spinal surgery by another surgeon. Patients often are worried about the recovery period following these large surgeries, and older individuals often worry about age and surgical risk factors.
Using careful examination of images and patients along with having realistic discussions with patients regarding their symptoms and expected results, Dr. Birinyi has been able to create injection and pain care plans for numerous patients, allowing them to have improved quality of life while avoiding larger and riskier procedures.
On the other hand, sometimes patients come to Dr. Birinyi as they are young, healthy, and engaged actively in the workforce. Patients sometimes cannot take the time to undergo a potentially beneficial surgical procedure at a given moment in life.
These patients often work with Dr. Birinyi to develop a pain care plan involving injections to temporize symptoms with minimal disruption to their work and personal lives.
The pain management world is much broader than epidural steroid injections. Dr. Birinyi works alongside several pain management physicians to ensure that patients have access to a complete array of pain management procedures and interventions.
Going along with epidural steroid injections, selective nerve root blocks can be performed, which use a different medication than epidural steroid injections. The nerves to the joints in the spine can also be blocked and even burned as another measure to provide pain relief to patients.
Trigger point injections, sacroiliac joint injections, and basivertebral nerve ablations are other tools available to Dr. Birinyi. Non-injection treatments like physical therapy and chiropractic care can be beneficial and used alongside injection treatments. Sometimes, injections allow patients to undergo physical therapy better without pain as part of the larger healing regimen.
Dr. Birinyi is happy to work with patients to formulate alternative pain treatments and nonsurgical pain management strategies, which are part of the complete neurosurgical workup and treatment of patients.
Most commercial insurance and Medicare cover the costs of epidural steroid injections, whether they are done in the office or surgery center setting.
Like with all procedures, insurance companies sometimes mandate a precertification process and waiting period; other times, no approval is necessary.
At Performance Spine and Brain, we work with patients to help them navigate their healthcare insurance, determine epidural steroid injection costs, and make every effort to have injections covered by insurance. Performance Spine and Brain also can discuss payment options if there are gaps in coverage.
If you have spine or nerve pain and would like an evaluation, we encourage you to give us a call. Our expert neurosurgical team will perform diagnostic tests and examinations to determine which treatment modalities may be helpful in a comprehensive pain management solution. We have expertise in epidural steroid injections and other advanced techniques to treat your spine and utilize the latest technologies in this endeavor. We seek to form a dialogue with you to individualize and optimize your plans of care.
Phone: 800-238-0827
Fax: 318-219-5221
[email protected]
Mailing Address
PO Box 11758
Alexandria, LA 71315
