Epidural Injections or Epidural Steroid Injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Effects of epidural injections tend to be temporary, providing relief from pain for one week up to one year. An epidural can be very beneficial for a patient during an acute episode of back and/or leg pain and can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program. If the initial injection is effective for a patient, he or she may have up to three in a one-year period.

In addition to the low back (the lumbar region), epidural steroid injections are used to ease pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.

How Epidural Injections Work

Epidural injections deliver steroids directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help "flush out" inflammatory mediators from around the area that may be a source of pain.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine or bupivacaine), and/or saline is used.

• A steroid, or cortisone, is usually injected as an anti-inflammatory agent. Inflammation is a common component of many low back conditions and reducing inflammation helps reduce pain. Triamcinolone acetonide, Dexamethasone, and Methylprednisolone acetate are commonly used steroids.
• Lidocaine (also referred to as Xylocaine) is a fast-acting local anesthetic used for temporary pain relief. Bupivacaine, a longer lasting medication, may also be used. Although primarily used for pain relief, these local anesthetics also act as "flushing" agents to dilute the chemical or immunologic agents that promote inflammation.
• Saline is used to dilute the local anesthetic or as a "flushing" agent to dilute the chemical or immunologic agents that promote inflammation.

The Procedure

Before Epidural Injections

An Epidural Steroid Injection usually takes between 15 and 30 minutes. The patient lies flat on an x-ray table on their abdomen. Prior to the epidural injection, the skin is numbed with lidocaine, which is similar to the Novocain that the dentist uses (a "local" anesthetic).

What to Expect During Epidural Injections

An epidural steroid injection is generally administered using the following process:

• Using fluoroscopy (live x-ray) for guidance, the physician injects steroids into the epidural space - that area that lies between the inner surface of the bony vertebral column and the outer, sleeve-like covering (the dura) of the spinal cord.
• The Epidural Steroid Injection procedure is usually not uncomfortable; however, sedation is available for patient anxiety and comfort. Sedatives are rarely necessary. If a sedative is used, the patient will need to be monitored for a longer period following the injection.
• The procedure takes about 30 minutes, plus approximately forty-five minutes recovery time.
• Following the injection, the patient is usually monitored for 15 to 20 minutes before being discharged to go home. Patients are usually asked to rest on the day of the epidural steroid injection. Normal activities (those that were done the week prior to the epidural injection) may typically be resumed the following day.

Cervical Epidural Injection

Learn more about cervical epidural injections by viewing the educational video below.