Epidural Steroid Injection
The dura is the membrane that surrounds the spinal cord. The epidural space is the space around the outside of the dura.
Medication
There are basically two types of steroids. The first type is the sex hormones, estrogen and testosterone. These are NOT used for epidural steroid injections.
The second type is the corticosteroids (often called "cortisone"), which have powerful anti-inflammatory properties (Androgenous steroids).
Epidural Steroid Injection
Your doctor may recommend an epidural steroid injection to relieve some types of back pain. An epidural injection (often known simply as an "epidural") places medication (usually an anesthetic and an anti-inflammatory steroid) directly into the epidural space. The medicine soaks into the nearby tissues and produces the desired effect (usually pain relief).
The nerves to the back, pelvis and legs can be irritated by pressure from a ruptured disc or narrowing of the spinal canal. An epidural steroid injection places medication directly beside these nerves. This injection usually decreases the inflammation and pain that is coming from the irritated nerves. In obstetrics, anesthetics are injected into the epidural space to reduce the pain during childbirth.
These injections may also be used to decrease the leg pain caused by pressure on the nerve roots in the lower back. The epidural steroid medications can help reduce the inflammation and the swelling associated with inflammation. Decreasing inflammation and swelling will decrease the pressure on the nerves and thus decrease the pain.
Epidural injections are done by injecting fluid medication through a needle that has been placed into the epidural space. This places the medication directly into the problem area. The goal is to decrease the local swelling and thus decrease the pain. The relief may be temporary or permanent.
Complications
Epidural steroids injections are generally quite safe. The major drawback is that they may not produce the desired relief. The most common adverse reaction is a headache after the procedure, which occurs in less than one percent of patients. Talk with your doctor about possible complications. Other risks are very rare and include infection or bleeding. The risk of paralysis is virtually nonexistent.
Before the Procedure
Epidural injections can be done at the hospital or at an outpatient clinic. The procedure is usually done on an outpatient bases and you won't have to stay overnight for this procedure. Make sure you give your doctor a list of ALL the medicines you are currently taking before the procedure. This includes non-prescription and over-the-counter medications. You should also be prepared to list all of your allergies, especially those to medications. Your doctor will probably ask that you not eat or drink anything for 4-6 hours before the procedure. You should also wash your back thoroughly with soap before the visit.
During the Procedure
The injection itself is completed while you sit, lie on your side, or less commonly, with you on your stomach. You will likely be asked to bend forward and push the lower part of your back backwards. Your doctor or a nurse will inject a local anesthetic (lidocaine, novocaine or a similar medication) to numb the skin and deeper structures near the site of the actual injection. The steroid medications will then be injected. You will be asked to talk to the nurse or doctor during the procedure. They will ask questions about what you feel.
After the Procedure
After about an hour in the recovery area, you should be ready to go home. You should plan to have a friend or family member drive you home after the injection. It takes a couple of days for the medication to work, so you may feel the same amount of pain, or perhaps even more pain than before, for the first couple of days. You should try to walk around your house and rest when necessary. Be careful not to move too much or do anything that might strain your back. Make sure to call your doctor if you have severe pain, headaches, a fever, or any swelling or redness around the area of injection on your back.