Chronic pain in the neck, back, arms, and legs caused by inflamed spinal nerves due to disc herniation or stenosis is more common than most people realize. The pain caused by such conditions can be so intense that they might restrict the movements of the patient and thus disrupt the normal activities they need to carry out to live a regular life.
To relieve such pain, Epidural steroid injection or ESI procedures are one of the most effective medical ways. It is one of the most effective nonsurgical treatments that require minimal invasion. The procedure can relieve pain for days or even for years.
So what is the standard procedure? Who does it? Are there any risks related? This blog post will let you know all that your need to know about a standard ESI.
What is epidural steroid injection or ESI?
The procedure of injecting a mix of appropriate steroid medicines in the epidural space of the spine is essentially called an epidural steroid injection or ESI. The steroid injection consists of an epidural corticosteroid like triamcinolone, methylprednisolone, or dexamethasone and an anesthetic or numbing medicine like lidocaine or bupivacaine. The analgesics or the pain relief medicines are given to the patient in the epidural space which is usually a fat-filled area between the protective cover of the nerves and the spinal bone.
The procedure of ESI is a minimally invasive procedure and contains no surgery, and yet it is effective since the effect can linger for years allowing the patients to carry on with their normal lives.
An epidural steroid injection is different than an epidural anesthetic injection that is given to pregnant women going into labor so that they do not feel the pain during the birthing process. Rather it is for patients struggling with chronic conditions involving a great amount of pain.
The epidural Steroid Injection procedure is majorly for chronic pain relief. So, patients who have pain in the back, neck, legs, or arms can benefit from an ESI procedure.
The major disorders that can cause such pain are;
The spinal canal and the nerve root canal become narrower in size and the narrowing becomes a source of back and leg pain. The leg pain might disrupt the normal mobility of the patient as the pain may be more severe and intense while walking.
The affected area of the spondylolisthesis is the vertebra. Due to a fracture between the upper and lower facet, the vertebra slips forward, squeezing the nerve root painfully.
This condition is created when gel-like deposition within the discs bulge out or burst out through a weak area to touch a spinal nerve. The content causes unbearable, immobilizing pain in the lower back.
As the intervertebral disc ages, the space between the discs collapses and causes tearing of the surrounding protective covering.
Pain runs along the sciatic nerve in the leg of the patient. The source of the pain is a compressed 5th Lumbar or 1st Sacral spinal nerve.
Who performs these pain relief injection procedures?
An array of physicians can perform pain relief ESI procedures. The types of physicians that perform the procedure include, surgeons, anesthesiologists, neurologists, and radiologists along with Pysiastrists or PM&R specialists.
Epidural steroid injection treatment procedure
Like most medical procedures, ESIs too have different steps at different stages of the procedure. The patient is prepared before the treatment while they also require aftercare when the procedure is done to heal better. So, here are the different stages of the procedure;
Before the treatment
Before the treatment, the doctor may make an appointment with you to review and discuss your medical history with you to make sure they know every and any medical condition you have. After understanding your medical history, they decide the best possible solutions for the challenges that they may face during the procedure due to any existing medical conditions. The patient can ask questions during this phase. In fact, patients are encouraged to ask doubts to their doctor and the person performing the procedure, about the procedure and medication involved.
During the treatment
The treatment starts with you signing consent forms. The procedure goes on for 15-45 minutes which is followed by a small recovery period. The medical professional performing the ESI procedure tries to give the injection as close to the inflammation site as possible for the best pain relief.
The first step of the procedure starts with getting the patient ready for the procedure. As they lie on the x-ray table, a local anesthetic is used on the treatment area where the needle is going to be inserted. The anesthetic makes sure that the discomfort is minimal as the patient stays awake and aware during the whole procedure for feedback purposes. A very low dosage of sedatives like Valium is given to the patient to keep them calm.
The next step is inserting the needle into the spine. With the help of a fluoroscopy x-ray machine, a needle is inserted through the body area into the epidural space. The fluoroscope allows the doctor to make sure if the needle is going to the right place.
The three types of ESI, are cervical epidural steroid injections, lumbar epidural steroid injections, and Caudal epidural steroid injections are named according to the injection site.
After the needle has been positioned, the medication is injected through the needed into the epidural space. Based on the requirements and needs, the procedure can be repeated for the left and right sides. The injection can also be given to multiple affected areas of the spine. Most patients don’t feel any pain or discomfort during the procedure and rather feel the pressure on the spine.
After the treatment
As the procedure is minimally invasive and doesn’t actually require any surgery, the recovery time is very little for the procedure. Most patients can resume movements the same day after the epidural corticosteroid injections have been given. The patient is observed for a little time and then discharged as they can go back to normal just by the next day.
A little bit of soreness on the site of injections and numbness of legs are a normal thing after the ESI procedure which is why it is advisable to have someone drive in and out of the facility where the patients get the epidural corticosteroid injections. The soreness of the injected site can be treated by a milf analgesic like Tylenol.
The patients are usually asked to maintain a pain journal after the procedure and an appointment with the treating physician is scheduled to take a follow-up from the patient for any possible allergic reaction or infections.
What are the results to expect?
Patients can expect to feel some pain relief after the first epidural injection. However, some might feel a mild relief only. For such cases, the patient is given spinal injections 2 to 3 times in the span of 1-4 weeks to reduce the pain completely. In the case of multiple epidural injections, the sessions are paired up with pain medicine and physical therapy to strengthen back muscles to avoid future pain episodes. Relief that comes from epidural injections can last up to a few weeks to a few years. It can get spare the patient of low back pain and any painful nerve while reducing inflammation in the spinal column.
Are there any risks related to ESI?
An Epidural Steroid Injection usually has very few serious complications and thus is considered to be the best non-surgical procedure for some patients. The potential risks involved in the procedure include spinal headache due to needle insertion, bleeding, infection, rare nerve damage or paralysis, and allergic reaction due to the dural puncture.
The steroids also have some side effects that can be included in the potential risks of ESI; the side effects include, weight gain, water retention, hot flushes, loss of sleep, and mood swings. It can also elevate the levels of blood pressure and blood sugar for patients who have a history of pressure and diabetes.
Patients who are being treated for chronic disorders related to the heart are advised to consult with their doctor before opting for ESI. The procedure is not done with patients with bleeding disorders to avoid complications and pregnant women as the x-rays of fluoroscopy can harm the baby.
Epidural steroid injections are a very good method of relieving patients of pain without surgery for a limited amount of time. However, it is important to remember that it is not a cure for the disorders like back pain, disc herniation, or the cause of any inflammation. Epidural injections are rather used to treat the symptoms, reduce inflammation, and help the patient resume their normal lives.