Spinal injection procedures are performed in order to both diagnose and treat different causes of back pain. There are multiple types of spinal injection procedures; the most commonly performed procedures include epidural injections, selective nerve root injections, and facet joint injections. The type of injection you receive is determined by your doctor based on the pattern and distribution of your symptoms and the results of other imaging studies such as lumbar spine CT or MRI.

How does an epidural steroid injection work?
There are two ways, in which an epidural steroid injection is believed to work.

First, some leg pain involves the inflammation of one or more of the nerves, their covering, or their roots, in the back. Thus, the injection of steroids directly into the part of the spinal column called the epidural space is thought to aid in reducing this inflammation.

The other way an ESI works is that the corticosteroid acts like a local anesthetic and block the pain long enough to allow the body to begin the process of repairing itself.

The chief effect of an epidural steroid injection is to reduce pain, but the effect differs from person to person. Most patients will achieve good relief for months after the injection. The goal of your injection is to provide relief so you can begin an appropriate exercise program and return to normal activities/work.

The radiologist will discuss the procedure with you and answer any questions you have before proceeding. You will be asked to lie on your stomach, and the appropriate site will be localized using fluoroscopy ("real-time" X-rays). After sterilizing and numbing your skin, the radiologist will advance a needle to the appropriate location, which may reproduce your usual symptoms. After injecting a small amount of contrast material to confirm the needle is in the proper location, the radiologist will inject a mixture of a steroid medication and an anesthetic agent, which often produces an immediate improvement in symptoms. The needle will then be removed, and the area bandaged. After a short observation period, you will be allowed to leave. The entire procedure usually takes about an hour, though occasionally more time is required.

Will I need more than one epidural steroid injection?
Approximately 40% of patients will receive significant pain relief with only one injection. Others require two or three injections to receive maximum symptomatic relief. The injections are usually scheduled at 2-week intervals. Even if epidural steroid injections provide relief, only in exceptional cases would more than three injections be justified within a six month period.

What should I expect after the epidural steroid injection?
Even if you feel better right away, avoid activities that may strain your back. You will be asked to put ice on the injection site for 20 minutes 2-3 times during the remainder of the day. After your injection you should feel the same or better for the first 12 hours. The local anesthesia will then wear off and you may experience a return of your pain. The steroid will start working within three days of the injection, with maximal relief at one week. Keep in mind most patients feel increased pain for the first 24 to 48 hours. You should start feeling some pain relief 2-3 days following the injection. This is because the steroid will start working within three days of the injection, with maximal effect by one week.

You should take as little of your usual pain medications as possible the morning of the procedure, though other prescribed medications should be continued. Be sure and inform the radiologist if you are taking any blood-thinning medications such as Coumadin. Remember to bring any outside CT or MRI studies with you if they were not performed at Great Basin Imaging.