An epidural steroid injection (ESI) is a
combination of a
corticosteroid with a local anesthetic pain relief
medicine. Corticosteroids are strong anti-inflammatory medicines. Relieving swelling and inflammation can take pressure off nerves and other soft tissues, which can relieve pain. The local anesthetic medicine helps give you immediate pain
relief. Corticosteroid medicines take longer to have an effect.
spinal canal, an ESI is injected into the space around the spinal cord and
nerve roots (epidural space).
sometimes are used to treat pain and inflammation from pressure on spinal
nerve roots. ESI is usually not tried unless symptoms caused by lumbar
spinal stenosis have not responded to other
Imaging tests, such as magnetic resonance
imaging (MRI) or computed tomography (CT) scans, are usually done before you are given the
injection. These tests are used to identify the exact location where nerve
roots are being squeezed. During the injection, an X-ray machine (fluoroscope)
is often used to guide placement of the needle.
An epidural steroid injection (ESI)
may be tried when other nonsurgical treatments have failed to relieve severe
leg pain from lumbar spinal stenosis.
The corticosteroids in an
ESI may help provide relief from leg pain by reducing swelling and
inflammation. Local anesthetics help relieve pain but
do not reduce inflammation. Lidocaine can also help relieve pain quickly,
before the corticosteroid has taken effect.
Lumbar spinal stenosis may cause pain
that radiates from the lower spine to the hips or down the legs. Epidural steroid
injections (ESIs) are used for leg pain rather than back pain from lumbar
Steroid injections may help relieve pain for a short time (2 to 3 weeks) in some people. Experts do not know how well injections work over longer periods of time.1
These injections may relieve symptoms and reduce inflammation but do not
cure spinal stenosis.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
or other emergency services right away if you have:
Call your doctor if you have:
One common side effect of this medicine is pain and swelling the first day or two after the
injection. It may help to apply ice at home for 15 to 20 minutes.
See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
If the steroid injection relieves your symptoms and your symptoms come back, your doctor may consider another injection. But steroid injections can damage soft tissues, so they are not given more than 3 or 4 times in a year in a single area.
A type of X-ray called fluoroscopy may be used to guide the needle placement for an epidural steroid injection.
The procedure usually takes less than 30 minutes. Then you are monitored for another 15 to 20 minutes before you go home. You will mostly rest on the day of the injection. Most people return to their normal activities the following day.
Your doctor will tell you what to watch for after you go home. Complications are rare, but can include infection, bleeding, nerve damage, and leaking of the fluid that surrounds the brain and spinal cord.
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
North American Spine Society (2007). Diagnosis and treatment of degenerative lumbar spinal stenosis: Evidence-based clinical guidelines for multidisciplinary spine care. Available online: http://www.spine.org/Documents/NASSCG_Stenosis.pdf.
May 14, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Robert B. Keller, MD - Orthopedics
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