- An epidural steroid injection places anti-inflammatory medicine next to an irritated nerve in the spine.
- It is used most for sciatica and arm pain from a herniated disc or spinal stenosis.
- The injection itself takes less than 5 minutes with X-ray guidance and local anesthesia, and you go home the same day.
- The steroid usually starts working within two to seven days. Relief can last weeks to months and gives you a window to rehabilitate.
What it is and who it helps
When a disc bulges or the spinal canal narrows, the nearby nerve can become inflamed. That inflammation causes pain, tingling or numbness that travels down an arm or leg. An epidural steroid injection delivers a small dose of anti-inflammatory steroid, usually with numbing medicine, into the epidural space right next to that nerve.
It helps most with:
- Sciatica and leg pain from a herniated disc
- Arm pain from a pinched nerve in the neck
- Leg pain and heaviness from spinal stenosis
It is less helpful for pain that stays only in the back or neck. That kind of pain often comes from the joints or muscles and is treated differently.
Before your injection
- Blood thinners: tell your physician about every blood thinner and anti-inflammatory you take. Do not stop any medication unless you are told to, and check with the doctor who prescribes it.
- Diabetes: steroids raise blood sugar for several days. Plan to check your sugar more often.
- Illness: call ahead if you have a fever, an infection or are taking antibiotics. The injection may need to be rescheduled.
- Allergies: mention any reaction to contrast dye, steroids, latex or local anesthetics.
- Sedation and driving: procedures are done under local anesthesia, without IV sedation, so you do not need a driver. If you would like an oral sedative, ask 2 to 5 days before your procedure and it will be called in to your pharmacy. If you take it, you must have a driver bring you and take you home.
During the procedure
- You lie on an X-ray table, usually face down. The skin is cleaned and numbed with a small needle.
- Using live X-ray, the physician guides a thin needle into the epidural space.
- A small amount of contrast dye confirms the medicine will go where it should.
- The medicine is injected. You may feel pressure or a brief reproduction of your usual pain. That is expected, and you should say so.
- A bandage is applied and you are watched for a short time before going home.
The injection itself takes less than 5 minutes. You are awake and able to talk throughout. That is intentional: it lets you report anything unusual.
Where it is done
All injections and procedures are performed in the surgery center on the 2nd floor of the Orlando Health Jewett Orthopedic Institute Downtown Complex, 60 Columbia Street, Orlando. Dr. Braithwaite’s clinic is on the 4th floor of the same building (Suite 400), and he also sees patients in Winter Park. Procedures are done under local anesthesia, without IV sedation.
Saturday and evening appointments. Because the practice is busy and many patients travel a long way to be seen, Dr. Braithwaite routinely offers Saturday clinic and Saturday procedures, along with some evening hours. If that would help you, please ask when you call.
Afterward
Take it easy for the rest of the day and return to normal activity the next day. The numbing medicine may give a few hours of relief, and an arm or leg can feel heavy or numb for a short time. Your usual pain may return, or be a little worse, for a day or two before the steroid takes effect.
Common, temporary steroid effects include facial flushing, trouble sleeping, feeling jittery and higher blood sugar.
How well it works and how long it lasts
Most people who are going to respond notice improvement within two to seven days. Relief may last a few weeks or several months. The injection does not repair a disc, but many disc herniations shrink on their own, and the injection can control pain while that happens and while you do physical therapy.
If the first injection helps only partly, a second may be recommended. Physicians limit the number given in a year to keep steroid exposure low.
Risks
- Soreness at the injection site
- A headache that is worse when you sit or stand, from a small leak of spinal fluid
- Infection or bleeding, both uncommon
- Nerve injury, which is rare
Serious complications are rare. The FDA requires a warning that epidural steroid injections can, rarely, cause serious neurologic problems (FDA safety communication). Image guidance, contrast and careful technique are used to lower that risk. Ask your physician about the risks for your specific injection.
When to call right away
- New weakness or numbness in an arm or leg that does not wear off
- Numbness in the groin, or loss of bladder or bowel control
- Fever, chills, or redness and drainage at the injection site
- A severe headache, especially one that is worse upright
- Severe pain that keeps getting worse
Call your physician’s office for any of these. If symptoms are severe or you cannot reach the office, call 911 or go to the emergency room.
Sources
This page is general education and is not medical advice. It does not replace an evaluation by your own physician, who knows your history and can examine you. If you have new weakness, numbness in the groin, loss of bladder or bowel control, or other emergency symptoms, call 911 or go to the nearest emergency room.