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Spinal Corticosteroid Injection
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Spinal Corticosteroid Injection

(Spinal Steroid Injection; Epidural Steroid Injection)

Definition

Injection of corticosteroids into tissue around the spine or spinal nerves exiting the spine. Corticosteroids are drugs that reduce painful swelling and irritation, called inflammation.

Parts of the Body Involved

  • The spine and spinal nerves
  • Tissue around the spine

Reasons for Procedure

  • To diagnose whether a specific site in the spine is the cause of persistent pain or disability
  • To reduce pain caused by swelling or inflammation around the spine
    • Some conditions which cause spinal pain/inflammation are: arthritis , spine trauma, post-surgical pain, herniated discs , spinal compression fractures, spinal stenosis (narrowing of the spinal canal where the spinal cord sits), radiculopathy (inflammation or narrowing of spinal nerve root as it exits spinal canal), degenerative disc disease (which can occur due to osteoporosis or advanced age), ankylosing spondylitis (inflammation at the sacroiliac joint in the lower back) and sciatica
  • Improve physical function for people with persistent low back pain and/or sciatica

Spinal injections are typically performed when persistent pain and disability are not relieved by:

  • Rest
  • Ice and heat therapies
  • Oral pain medication
  • Muscle relaxants
  • Physical therapy
  • Back exercises
  • Changes to the physical set-up of the work environment
  • Changes to physical activities, including work
  • Spinal manipulation

Risk Factors for Complications During the Procedure

  • Current infection
  • Certain pre-existing medical conditions
  • Treatment with blood thinners
  • General ill health
  • History of Epilepsy (if anesthetic is used with the corticosteroid)
  • Concurrent use of the following drugs- Discuss with your doctor prior to the procedure if you use these drugs and will be receiving anesthetic along with the corticosteroid injection:
    • Calcium antagonists
    • Beta blockers
    • Pethidine ( meperidine ) or phenytoin
    • Cimetidine
    • Acetazolamide
    • Baclofen
    • Flumazenil

What to Expect

Prior to Procedure

Your doctor or another healthcare professional will likely do the following:

  • Perform a brief physical exam
  • Review your medications and decide if you need to stop taking some before the procedure
  • Insert a tube into your vein to deliver a sedative
  • Attach sensors to your chest to monitor your heart rate and breathing (possibly)

Anesthesia

A local anesthetic and/or a sedative may be used to alleviate pain and anxiety associated with the procedure, but are generally not used to put you to sleep.

Description of the Procedure

You will lie on your side on an x-ray table. The skin on your back will be washed with a sterile solution. The doctor will have a syringe containing corticosteroid medication and a local anesthetic. He or she will insert the needle through the skin and into a space near the spine. This space may be the epidural space or another space between bones of the spine. The doctor will likely use x-rays imaging to guide placement of the needle into the proper space near the spine. Contrast dye may also be injected to confirm that the needle is in the right place. The doctor will inject the medication and remove the needle from your back. A small bandage may be placed over the injection site after the procedure.

Corticosteroid Injection

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After Procedure

  • You will spend time in a recovery area.
  • A healthcare professional will check your vital signs and monitor your condition.
  • You will need someone to drive you home, because you were sedated during the procedure.

How Long Will It Take?

The procedure will take less than one hour. The entire visit is about 2-3 hours, including preparation time and monitoring in the recovery room.

Will It Hurt?

The injection of the local anesthetic may burn or sting for a few seconds. After that, you should not feel pain during the procedure.

Possible Complications

  • Spinal headache
  • Allergic reaction to the medication
  • Bleeding (rare)
  • Infection (rare)
  • Nerve damage (rare)
  • Seizure (if anesthetic is used - rare)
  • Syncope (fainting)

Average Hospital Stay

Less than one day.

Postoperative Care

  • Rest on the day of the procedure.
  • Apply ice packs for soreness at the injection site.
  • Avoid baths, pools, and whirlpools for 24-48 hours.

Outcome

It will take a few days to a week, maybe longer, for the medication to reduce the inflammation and pain. You should be able to resume your regular daily activities the day after the procedure. You should be able to start exercising within one week.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, bleeding, or discharge from the injection site
  • Sudden shortness of breath or chest pain
  • Weakness or paralysis
  • Numbness, tingling, pain, or weakness, especially in the arms, hands, legs, or feet

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

American Association of Neurological Surgeons
http://www.neurosurgerytoday.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org

Canadian Orthopaedic Foundation
http://www.canorth.org/default.asp

References:

American Academy of Orthopaedic Surgeons (AAOS). AAOS clinical guideline on low back pain/sciatica (acute) (phases I and II). Available at: http://www.guidelines.gov/summary/summary.aspx?doc_id=5369&nbr=003672&string=spinal+AND+fusion . Accessed September 9, 2005.

Jain, KK. Neurologic complications of local anesthesia. In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed May 31, 2008.

Manchikanti L, Staats PS, Singh V, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Phys. 2003;6:3-81.

Ramachandran, TS. Lumbar spinal stenosis and neurogenic claudications. In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed May 31, 2008.

Spinal injections. North American Spine Society website. Available at: http://www.spine.org/articles/injections.cfm . Accessed September 7, 2005.

Wheeler AH. Therapeutic injections for pain management. eMedicine . 2005. Available at: http://www.emedicine.com/neuro/topic514.htm . Accessed September 16, 2005.



Last reviewed May 2008 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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