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The epidural steroid injection usually takes about 15 to 30 minutes to
complete. The patient may sit and lean forward, or lie on his or her
stomach or side with the back arched. Prior to the injection, the
skin is numbed with lidocaine, a local anesthetic similar to the
novacaine used by dentists. Then the physician will locate the
appropriate spot for the injection. Using fluoroscopy (live x-ray)
for guidance, the physician directs a needle toward the epidural
space. Fluoroscopy is considered important in guiding the needle
into the epidural space, as controlled studies have found that
medication is misplaced in 13% to 34% of epidural injections that
are done without fluoroscopy. Once the needle is in the exact
position, steroid solution is injected. At times a flushing
solution, such as lidocaine or normal saline, is also used to help
“flush out” inflammatory proteins from around the area that may be
the source of pain.
Following the injection, the patient is usually monitored for 15 to
20 minutes before going home. Typically, patients are asked to rest
on the day of the injection and allowed to return to their normal
activities on the following day.
Potential risks and side effects
With all invasive medical procedures, there are potential risks.
Generally, however, there are few risks associated with epidural
injections and they tend to be rare. Risks may include:
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Infection. Minor infections occur in 1% to
2% of all injections. Severe infections are rare, occurring in
0.1% to 0.01% of injections.
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Bleeding. Bleeding is a rare complication and is more
common for patients with underlying bleeding disorders.
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Nerve damage. While extremely rare, nerve damage can occur
from direct trauma from the needle, or secondarily from
infection or bleeding.
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Dural puncture (“wet tap”). A dural puncture occurs in 0.5%
of injections. It may cause a post-dural puncture headache (also
called a spinal headache) that usually gets better within a few
days. Although rare, a blood patch may be necessary to alleviate
the headache.
Paralysis is not a risk since there is no spinal cord in the region
of the epidural steroid injection.
In addition to risks from the injection, there are also potential
risks and side effects from the steroid medication. These side
effects tend to be rare. Risks and side effects may include:
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A transient decrease in immunity |
• |
Transient flushing |
| • |
High blood sugar |
• |
Increased appetite |
| • |
Stomach ulcers |
• |
Severe arthritis of the hips (avascular necrosis) |
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Transient flushing |
Lumbar epidural steroid injections should not be performed on
patients who have a local or systemic bacterial infection, are
pregnant (if fluoroscopy is used) or have bleeding problems.
Epidurals should also not be performed on patients whose pain is
from a tumor or infection, and if suspected, an MRI scan should be
done prior to the injection to rule out these conditions. Injections
may be done, but with extreme caution, for patients with allergies
to the injected solution, uncontrolled medical problems (such as
congestive heart failure and diabetes), and those who are taking
aspirin or other antiplatelet drugs (e.g. Ticlid, Plavix).
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