Epidural Steroid Injection
Understanding Radiculopathy (Sciatica) and Epidural Steroid Injection
Radiculopathy, often called sciatica when it affects the leg, happens when a spinal nerve is compressed or inflamed. This can cause sharp shooting pain, numbness, tingling or weakness that travels from the back into the buttock, leg or arm. Everyday activities like walking, sitting or working can become very difficult.
An epidural steroid injection is a minimally invasive procedure that delivers anti‑inflammatory medicine directly around the irritated nerve roots in the spine. Using X‑ray or ultrasound guidance, a thin needle is placed into the epidural space and a mixture of local anaesthetic and steroid is injected. By reducing inflammation at the source, an epidural steroid injection can ease radicular pain (sciatica), improve mobility and support your overall spine rehabilitation plan.
Radiculopathy is a condition characterized by pain, weakness, numbness, or tingling that radiates along the path of a nerve root. This typically occurs when the nerve root becomes compressed or irritated due to various factors such as herniated discs, spinal stenosis, degenerative changes in the spine, or injury. Symptoms of radiculopathy can vary depending on which nerve root is affected and where along the spine the compression or irritation occurs.
In Cervical Radiculopathy, compression or irritation of nerve roots in the neck region (cervical spine) can lead to symptoms such as neck pain, shoulder pain, arm pain, and weakness or numbness that radiates down the arm and into the hands and fingers. In Lumbar Radiculopathy, Compression or irritation of nerve roots in the lower back (lumbar spine) can cause symptoms such as lower back pain, buttock pain, leg pain (sciatica), and weakness or numbness that radiates down the leg and into the feet and toes.
An ESI is a minimally invasive procedure that is used to alleviate radiculopathy. It involves injecting a corticosteroid medication around an inflamed nerve as it exits the spine. Corticosteroids are potent anti-inflammatory medications. As such, when injected around the nerve roots, they result in rapid reduction in inflammation of the nerve.
During an ESI, the patient is positioned comfortably on their stomach or side, and the skin over the injection site is sterilized. Using imaging guidance (Typically X-rays or Ultrasound) to ensure precision, a needle is inserted into the epidural space in the spine under local anesthesia. Once the needle is correctly positioned, a mixture of corticosteroid medication and local anesthetic is slowly injected into the epidural space. The medication spreads around the inflamed nerves, reducing inflammation and providing pain relief.
After the injection, the needle is carefully removed, and the injection site is covered with a small bandage. The entire procedure usually takes about 15 to 30 minutes, and patients can typically return home the same day with instructions for post-injection care.
In most cases, the pain will decrease substantially minutes after the injection has bee performed. This is because local anesthetics are injected around the nerves. However, it is not uncommon for the pain to recur after a day when the effects of the local anesthetics wear out. Thereafter, the corticosteroids will take about 2 to 3 weeks to take effects.
The level of pain experienced during an epidural steroid injection (ESI) can vary depending on factors such as individual pain tolerance and the technique used.
While some patients may feel a brief pinch or pressure sensation during needle insertion, local anesthesia is typically administered to minimize discomfort. Patients may experience temporary discomfort or pressure as the medication spreads around the nerves, but this usually subsides quickly. Overall, an ESI is generally well-tolerated by most patients (even those who are needle-phobic).
Epidural steroid injections (ESIs) are considered to be safe. However, you should be aware of some of the potential side effects:
Common
-
Pain at the injection site lasting for a few days
-
Temporary increase in blood pressure and blood surgar levels lasting 2 weeks
Rare (less than 1:100)
-
Temporary increase in pain
-
Headaches
Very rare
-
Allergic reaction to contrast / medications
Extremely rare (less than 1:10,000)
-
Infection
-
Bleeding
-
Nerve damage