Treatments
3. Epidural Steroid Injection
Objective: Relief from pain caused by inflammation in the nerves, ligaments, and disks of the spine. Symptoms: Arthritis, numbness and weakness characteristic of spinal stenosis. For disk herniation, pain may be felt anywhere from the back of the hand to the foot, depending on the location of the herniation. Indicated for: Disk herniations, spinal stenosis, or arthritis of the spine.
Pre-Treatment: If sedation will be required (rare), eat/drink nothing after midnight, and continue your normal medications (except those below) with a sip of water. Medications: 7 days before the procedure, stop Plavix. 14 days before, stop Coumadin and Warfarin. 5 days before, stop Ticlid (ticlopidine).
Treatment: The epidural space is an area behind the spinal cord and spinal fluid that the nerves cross through in order to leave the spine. We inject corticosteroids (not the same thing as body-builder steroids) into that space, forming a reservoir from which the steroids gradually dissolve, coating the nerves and relieving inflammation. Depending on the condition, we make the injections into your back, low back or side of the neck.
Relief Time: Relief lasts 3-24 weeks or longer. Pain Associated with Treatment: Minimal. Recovery Time: Epidural steroids will not cure spinal stenosis or dissolve/reduce disk herniation size (only surgery or the body’s own enzymes can do this). Rate of Complications: Bleeding, infection, nerve injury, spinal cord injury, abscess or blood clots, paralysis, spinal fluid leak with headache, and failure to relieve pain are all risks. Discuss specific risks with your physician prior to the procedure during consultation.
Post-Treatment: Driver needed.
Discharge Instructions: You may experience some numbness in the skin over the back during the first several hours. Relief from the diagnostic injection may last up to 12 hours. Relief from a steroid injection will begin in 12-24 hours.
You may have some numbness in the leg, arm, foot, or hand after the injection. If this was not discussed as a possibility, call your physician to report this, and be extremely careful about walking or standing if this occurs since there is an increased risk of falling.
Normal activity, diet, and medications can be resumed same day. If we place any Band-Aids over the injection site, they can be removed the next day. If you feel discomfort at the injection site, apply ice wrapped in a washcloth for short periods of time (20 minutes per hour) during the first 24 hours, then apply low to medium heat after that. You might experience soreness and bruising around the IV site, which will go away in a few days. Placing a warm moist cloth over the area for half-hour periods several times a day may help.
Side Effects: Side effects include elevated blood sugar for a week, especially if you are diabetic. (If so, plan to check your blood sugar more frequently for the first week after an injection.) Steroids may also cause increased blood pressure for a week. If you have hypertension and/or taking hypertension medications, you’ll need to check your blood pressure more often during the first week. Medication doses for diabetes and high blood pressure may have to be adjusted by your primary care doctor if these are elevated. Some patients experience facial or chest redness, or have excessive energy, during the first 24 hours after the injection.
Anesthetic Effects: If sedation is given, refrain from operating motor vehicles within the first 12 hours after the injection, and do not consume alcohol or sedatives, or make important decisions such as signing legal papers, within 24 hours after the injection.
Notify Us Immediately If: 1. You develop fever of more than 101 degrees during the first few days after the injection. 2. You have new weakness or numbness in the arms or legs, severe increased pain in the back or neck, or loss of bowel or bladder control. 3. You experience increased swelling of the hand or increased tenderness or red streaking around the area of the IV site. 4. You experience severe, generalized, new-onset weakness during the first week after the injection.