Steroid Injections in the Epidural Space: Advantages, Drawbacks, Outcomes, and Beyond
Epidural Steroid Injections (ESIs) are a common treatment option for individuals suffering from chronic spinal pain. These injections aim to provide relief from conditions such as lower back pain that radiates to the lower body, and neck pain that may radiate down to the arms.
ESIs offer short- or long-term benefits, helping people return to their everyday activities or physical therapy. However, multiple ESIs for chronic pain management carry potential long-term risks, primarily related to cumulative steroid exposure.
Who Can Benefit from ESIs?
People suitable candidates for ESIs are those with inflammation of the spinal nerves, which can cause lower back pain radiating down through the legs, or neck pain radiating to the arms. Conditions such as spinal stenosis, herniated disc, radiculitis, sciatica, degenerative disc disease, bone spurs, spondylolysis, spondylolisthesis, thickening of the ligamentum flavum, scoliosis, post-laminectomy syndrome, compression fracture, damage to nerve fibers following shingles or injury, cysts on the nerve roots may make one a suitable candidate.
The Procedure and Its Risks
The ESI procedure involves a doctor injecting a steroid into the epidural space, an area of fat and blood vessels within the spinal canal that surrounds the spinal cord and spinal nerves. A doctor may use X-ray to guide the needle during the procedure.
Common short-term risks include infection, headache, and temporary blood sugar or pressure increase. Long-term risks include steroid side effects (hormonal/metabolic), rare nerve damage, and serious complications such as epidural hematoma, meningitis, paralysis, or stroke (very rare).
Monitoring and Best Practices
Guidelines recommend monitoring cumulative steroid dose to avoid excessive exposure, with upper limits such as 240 mg methylprednisolone or triamcinolone per year. ESIs are not considered standalone cures but part of a broader pain management plan including physical therapy, posture correction, and lifestyle changes to minimize reliance on injections.
Types of ESIs
There are three types of ESI: Interlaminar, Transforaminal, and Caudal. Interlaminar ESI involves injecting steroid into the back, into the middle of the spine, while Transforaminal ESI injects steroid into an affected spinal nerve root. Caudal ESI injects steroid into the lower back.
Preparing for an ESI
Before an ESI procedure, people may need to discuss any medical conditions, medications, or allergies with a doctor, change into a surgical gown, and may receive a mild sedative or local anesthetic. A team of healthcare professionals, including a doctor with specific training in delivering ESIs, a nurse or assistant, a radiologist to operate the fluoroscopy, and an anesthesiologist, will be involved in providing an ESI.
Side Effects and Recovery
Side effects of an ESI may include flushing, increased temperature, sleeping problems, changes in menstrual cycle, water retention, anxiety, pain that may increase in the days following the procedure, temporary pain in the back or lower limbs, adrenal suppression, postdural puncture headache, and paralysis (rare).
ESI is usually an outpatient procedure, meaning people will only need to be in the healthcare facility for the length of the procedure and can return home after the injection.
Conclusion
The risk-benefit balance of ESIs should be individually assessed for each patient with chronic spinal pain considering ESIs. Patients should discuss individual risks with their providers and seek a comprehensive treatment approach that includes regular exercise, maintaining a moderate weight, eating a balanced diet, avoiding or quitting smoking, and combining ESIs with rehab, therapy, and lifestyle adjustments.
- CBD, a compound found in cannabis, is sometimes used by individuals to manage chronic pain, as an alternative to traditional pain medications like those used in Epidural Steroid Injections (ESIs).
- Science continues to explore the potential benefits of chronic disease management, with research focusing on treatments for conditions like chronic kidney disease and other medical-conditions that may require pain medications such as those used in ESIs.
- As part of a health-and-wellness regimen, individuals undergoing ESIs for chronic spinal pain may also be advised to incorporate lifestyle changes like physical therapy and posture correction to minimize reliance on pain medications and optimize overall well-being.
