Epidural shots for back pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The envelope that encloses the spinal cord and nerve roots in the spine is called the dura.
The space surrounding the dura is the epidural space. Nerves travel through the epidural space in the low back to both the back as well as to the legs. Inflammation of these nerve roots may cause pain due to irritation from a degenerated disc or bone spur.
An epidural steroid injection is an injection of cortisone.
An epidural injection places the cortisone into the epidural space to decrease inflammation of the nerve roots, reducing the pain in the back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a shorter period of pain relief lasting several months.
To administer the epidural steroid injection, you will be placed in either a seated position or be asked to lie face down. The skin on the back is cleaned. Next, the physician numbs the skin. After the numbing medicine, the physician will start the procedure. Using either diagnostic ultrasound or fluoroscopy to identify landmarks, a needle will be advanced to an area very near to the epidural space. A mixture of lidocaine and cortisone is injected. The epidural steroid injection procedure takes about 15 minutes.
Epidural steroid injections may be given by many types of physicians, including anesthesiologists, rheumatologists, orthopedic surgeons, neurologists, interventional radiologists, and others trained in this technique. Usually a series of injections, often three, each spaced a week apart, are given. Most patients find relief of symptoms within a few weeks.
Side-effects from epidural steroid injections are rare, but should be discussed. These include:
• Infection: Very unusual (less that 0.5%), and avoided by using sterile technique.
• Bleeding: Also unusual, and avoided by not performing this procedure on patients with bleeding disorders or those on blood thinning medication.
• Dural leak: Caused by leakage of spinal fluid from the sac from the puncture site. This usually results in a headache.
• Increased blood sugar: Diabetics must monitor their blood sugar after this or any other steroid injection.
Other side-effects are possible, and should be discussed prior to injection with the doctor performing this procedure.
Again, epidural steroid injections should be administered using either ultrasound or fluoroscopy for guidance of the needle.
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