An epidural steroid injection (ESI) is a procedure that can help minimize spinal nerve inflammation caused by spinal stenosis or disc herniation, which in turn helps relieve pain in the affected area (neck, arm, back, or leg). Dr. Moustafa Ahmed administers medications that are injected in the epidural space, which is the area between the dura matter-protective membrane and the epidural space containing fat, small blood vessels, and spinal nerves. The pain relief period ranges from several days to years. The treatment goal is to minimize pain so that you may resume your daily activities and physical therapy.
EPIDURAL STEROID INJECTIONS (ESI)
A steroid injection consists of two medications: a corticosteroid and a numbing medication. The drugs are injected into the epidural space of the spine. Steroid injections are usually effective when injected into the painful area directly. They can decrease inflammation but they will not have any therapeutic effect on the herniated disc; it only works on the nerves by flushing away the inflammatory substances that cause nerve swelling. Pain relief duration ranging from days to years will allow you to retain your daily activity and the ability to commence any physical therapy or exercise program needed to improve your spine condition.
BEFORE THE PROCEDURE
The doctor will review your medical history and previous diagnostic images to plan the site of the injections. You can ask any questions you may have in regard to the procedure. We use a contrast dye to visualize the final location of the needle. If you are allergic to the contrast, please notify your physician. If you take aspirin or a blood thinner, we will contact your PCP/cardiologist to get instructions. You may need to withhold them for several days prior to the procedure. The PCP/cardiologist will explain the risk of withholding your blood thinner.
The procedure is usually performed in our office’s state-of-the-art procedure room. Please arrange to have an adult accompany you in order to drive you home from the office following your procedure.
DURING THE PROCEDURE
Before the procedure, you will sign a consent form. The procedure may last 15-45 minutes. Following the procedure, you will be observed for a period of time prior to discharge.
The doctor will inject the medication as close to the painful nerve as possible. The procedure technique and medication used is determined by your condition and if you have had any previous surgeries resulting in metal rods or screws being implanted. Achieving the best result is our goal.
Step 1: preparation
While lying on an x-ray table, your skin will be numbed in the treatment area to minimize
discomfort during the procedure. You will remain awake during the procedure to provide feedback. If you decide to have sedation-induced, discuss this option with your physician.
Step 2: needle insertion
Under fluoroscope (special X-ray) guidance, the doctor inserts a needle through the skin into the epidural space. Fluoroscopy allows your doctor to watch the needle in real-time on the monitor to ensure that the needle goes to the correct location. Contrast is usually injected to confirm the precise needle position. Most patients experience some discomfort, occurring as pressure rather than pain.
Step 3: medication injection
When the needle is in the correct location the anesthetic (numbing) agent and steroids are injected, then the needle is removed.
AFTER THE PROCEDURE
Patients can usually walk around directly after the procedure and can leave the clinic after being observed for a short time and accompanied by an adult.
On the next day, you should be able to resume full activity. Ice is your friend to relieve injection site soreness; you can also take mild analgesic (Tylenol).
You will be given a diary sheet to record your pain levels for the next two weeks. It is normal to have a mild increase in pain, numbness, or weakness as the numbing medicine wears off and before the steroid starts to take effect.
Many patients report some pain relief from ESI. If you notice only slight pain relief, your doctor will perform one to two more injections at 2-4 week intervals to reach maximum effect. Pain relief duration vary from weeks to years. Injections will help you participate in physical therapy and/or a home exercise program. Exercise will strengthen your back muscles and will help prevent future pain.
To learn more about the Pain Management Clinic at CLS Health, call 281-985-5984 to schedule an appointment, or speak with a nurse.