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Epidural Steroid Injection; What you should know.


By: Dr. Nicholas LaHood, D.C.

Epidural Steroid Injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still a big part of the management of sciatica and low back pain. The goal of the injection is to relieve pain; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with other medications to provide an additional benefit.

Most practitioners will agree that, while the effects of the injection tend to be temporary - providing relief from pain for one week up to one year - an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief but leaves the underlying condition which created the lower back pain to return another day. Mainly the common cause is a degenerative or herniated disc. If the initial injection provides any relief for a patient, he or she may have up to three in a one-year period.

In addition to the low back (the lumbar region), epidural steroid injections are used to ease pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.

Although many studies document the short-term benefits of epidural steroid injections, the data on long-term effectiveness are less convincing. Indeed, the effectiveness of lumbar epidural steroid injections continues to be a topic of debate. It is recognized that these injections don’t prevent the arthritis or disc degeneration from progressing further and leaving the patient worse off than before if the proper treatment had been given to start.

Potential Risks and Side Effects as with all invasive medical procedures, there are potential risks associated with lumbar (lower back) Epidural Steroid Injections. Generally, however, there are few risks associated with epidural steroid injections and they tend to be rare. Risks may include:

  • Infection. Minor infections occur in 1% to 2% of all injections. Severe infections are rare.

  • Bleeding. Bleeding is a rare complication and is more common for patients with underlying bleeding disorders.

  • Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the needle, or secondarily from infection or bleeding.

  • Dural puncture (“wet tap”). A dural puncture occurs in 0.05% of injections (also called a spinal headache) although rare, a blood patch may be necessary to alleviate the headache.

In addition to risks from the injection, there are also potential side effects from the steroid medication. These side effects tend to be rare, though they become more common when oral steroids are taken daily for several months. These risks and side effects may include:

  • A transient decrease in immunity

  • High blood sugar

  • Stomach ulcers

  • Severe arthritis of the hips (avascular necrosis)

  • Cataracts

  • Transient flushing

  • Increased appetite

Dr. Nicholas LaHood specializes in treatment protocols that are drug-free and non-invasive. If you are suffering from severe lower back or neck pain and or you are getting painful steroid injections, call the office right away to schedule an evaluation.

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