September 14, 2020
The Safety of Epidural Steroid Injections
Epidural steroid injections are commonly used to treat pain. One of the greatest benefits of these injections is that they are outpatient injections that provide relief without the patient having to undergo surgery. All surgeries have risks, but spinal surgeries can be invasive and worrisome for patients. Injections are a great treatment that should be explored prior to surgery.
What Is An Epidural Steroid Injection
First and foremost, the back or neck area where the injection will be given is cleaned with alcohol and antiseptic. A local anesthetic is administered to numb the area prior to the injection. This can cause a brief burning or stinging sensation that wears off quickly. The doctor will then use x-ray guidance to place the small epidural needle into the epidural space. Epidural space is the space in the spine right outside of the dural membrane that covers the nerve roots and spinal cord. Nerves in this epidural space travel to the back and down into the legs. When these nerves become inflamed they can cause pain in the regions they travel to.
X-ray dye will be injected into the needle to confirm that the needle is in the correct location. Once that has been confirmed, the steroid medication such as Kenalog or Depo-Medrol is then injected into the patient’s epidural space. These injections can help reduce inflammation which results in pain relief.
Epidural steroid injections are not a solution to correct a pre-existing condition such as arthritis, spinal stenosis, or a herniated disc, but they are very successful in providing pain relief and helping patients manage pain. Injections are typically given in a series with 3-4 weeks between each injection. Some patients will find relief after just one injection, but it’s not uncommon for patients to need more.
Too many injections in the same area can also cause tissue to break down over time. Patients can get more than one injection, but doctors will typically limit the number of injections they are willing to give to a patient per year in order to avoid any tissue breakdown. Three to four injections per year per body region is the recommended limit.
History and Safety of Epidural Steroid Injections
The first documented epidural injection was administered in 1902. At that time, cocaine was injected in the lumbar spine and used to treat sciatica. Advances in medicine and science have greatly improved this procedure since it’s debut in the early 1900s. These injections have been endorsed by the North American Spine Society and the Agency for Healthcare Research and Quality. Epidural steroid injections have been classified as an integral part of nonsurgical pain management.
Nearly 250,000 cervical or thoracic epidural injections were performed in 2013 on US Medicare patients alone. These injections have been used for over 100 years and are administered to hundreds of thousands of patients per year. Because patients do not need to be put under any general anesthesia and the injection does not need a large incision site, the risks of complications are low. The sanitary measures that are taken prior to administering an injection also help to greatly reduce the risk of infection. Infection occurs in less than 1% of injection cases.