Epidural Steroid Injections (ESI)

A common procedure, epidural steroid injections place a powerful anti-inflammatory agent (either steroid or anesthetic agent) into the epidural space for good benefits with minimal risk factors. Because of its low risk and low incidence of significant problems or side effects, this procedure is felt to be a reasonable option when traditional, conservative disc pain therapies have failed to provide improvement.

Epidural Steroid Injections (ESI) shrink swelling and inflammation in bulging or herniated discs that may be pressing on a spinal nerve.

Post Procedure. Patients are advised to rest on the day of the epidural, although bed rest, while preferable, is not required. By the next day, previous activities can be resumed. An occasional patient will feel such significant relief that they are tempted to resume various strenuous activities. They are cautioned not to do this, however. It is generally advised to pursue a course of gradual increase in activity, often coordinated with physical therapy or other training once the injections have been completed.

Results. A large percentage of patients upon whom this procedure is performed will get complete resolution of symptoms; a small percentage may experience no real improvement at all. It is generally an accepted practice that this procedure be repeated up to three times within a few months, although in some cases, additional injections may be administered. Injections may be given as a single dose, or once a week for up to three weeks. Although not to be expected immediately, improvement will likely occur over the next several days to two weeks.

Possible Side Effects & Risks. Adverse reactions are rare. Some of these potential (uncommon) side effects include fluid retention, “puffiness” and (rarely) acne. An additional (albeit extremely rare) risk is the possibility for the epidural needle to nick the dure (the covering of the spinal cord). Should this occur, there could be leakage of cerebrospinal fluid, which could cause a severe “spinal headache.” If this should happen, bed rest and an increase in fluid and caffeine intake frequently will alleviate the headache completely. Should this not resolve the problem, it may be necessary to perform a “blood patch.” Under sterile conditions, blood is removed from a vein in the arm and placed into the same epidural spce, completely resolving the headache symptoms. Since this is the most common adverse event that may occur from epidural injections, the remaining potential complications should not scare you, but make you more informed.

Other potential risks include: worsening of symptoms, bleeding, infection, backache, steroid side effects, bowel or bladder dysfunction, hematoma, cord compression, paralysis, neurologic damage or impairment, or death. One of the most serious side effects (which is extremely rare) is the development of an epidural infection or abscess. To minimize these risks, the procedure is done under strict sterile conditions, utilizing fluoroscopy to localize the epidural space and guide the needle.