The epidural steroid injection usually takes about 15 to 30 minutes to complete. The patient may sit and lean forward, or lie on his or her stomach or side with the back arched. Prior to the injection, the skin is numbed with lidocaine, a local anesthetic similar to the novacaine used by dentists. Then the physician will locate the appropriate spot for the injection.

Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space, as controlled studies have found that medication is misplaced in 13% to 34% of epidural injections that are done without fluoroscopy. Once the needle is in the exact position, steroid solution is injected. At times a flushing solution, such as lidocaine or normal saline, is also used to help “flush out” inflammatory proteins from around the area that may be the source of pain.

Following the injection, the patient is usually monitored for 15 to 20 minutes before going home. Typically, patients are asked to rest on the day of the injection and allowed to return to their normal activities on the following day.

• When is an epidural steroid injection typically recommended? • How is the epidural steroid injection performed? • What are potential risks and side effects of an epidural steroid injection?

Potential risks and side effects
With all invasive medical procedures, there are potential risks. Generally, however, there are few risks associated with epidural 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, occurring in 0.1% to 0.01% of injections.

• 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 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually gets better within a few days. Although rare, a blood patch may be necessary to alleviate the headache.

Paralysis is not a risk since there is no spinal cord in the region of the epidural steroid injection.

In addition to risks from the injection, there are also potential risks and side effects from the steroid medication. These side effects tend to be rare. Risks and side effects may include:

Lumbar epidural steroid injections should not be performed on patients who have a local or systemic bacterial infection, are pregnant (if fluoroscopy is used) or have bleeding problems. Epidurals should also not be performed on patients whose pain is from a tumor or infection, and if suspected, an MRI scan should be done prior to the injection to rule out these conditions. Injections may be done, but with extreme caution, for patients with allergies to the injected solution, uncontrolled medical problems (such as congestive heart failure and diabetes), and those who are taking aspirin or other antiplatelet drugs (e.g. Ticlid, Plavix).

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