29 Nov How Long Does it Take for an Epidural Steroid Injection to Take Effect?
An epidural steroid injection procedure is a technique where a corticosteroid medication and local anesthetic agent is injected into the epidural space around the spinal cord. This epidural space is an anatomical area that is the outermost part of the spinal cord.
Medical indications for an epidural steroid injection include the following conditions which can present with signs and symptoms such as pain, numbness, and or power loss in the lower back or legs:
- Spinal disc herniation – where a tear in the outer, fibrous part of a disc located between the spinal bones (vertebrae) results in leakage or protrusion of the soft, gel-like material inside this structure. This may then press on or irritate nerve roots coming out of the spinal cord.
- Spinal stenosis – which is narrowing of the spinal canal causing compression of the spinal cord.
Epidural steroid injections are usually performed on an out-patient basis where patients have the procedure done at a day surgery clinic. The procedure includes the following steps:
- The skin where the injection is to be inserted is administered with local anesthesia and the patient is mildly sedated.
- The procedure entails injecting through the skin, fat and muscle layers of the affected area and penetrating the epidural space to deliver the medication into this cavity.
- To facilitate fewer side effects and complications, imaging guidance with a radiocontrast agent or fluoroscopy is used to help navigate the needle to the correct area where the medication needs to be administered.
The areas of the back where epidural injections are performed include the lower part (lumbar spine) and the thoracic/mid-back region. Epidural steroid injections are sometimes performed around the neck (cervical spine), but not too often due to the possibility of injuring the spinal cord and causing severe complications.
- The local anesthetic that is injected into the epidural space begins to work immediately to offer pain relief. The corticosteroids will work within a couple of days to a week to reduce inflammation in the area caused by the mentioned conditions.
- The lumbar epidural steroid injection recovery time is reduced if patients begin their physical therapy program shortly after pain relief has been achieved.
- Some patients may experience worsening pain after the injection. They are advised to use anti-inflammatory medication and apply cold and ice packs to the injection site to help relieve this pain.
Safety and efficacy
A study was conducted to look at the safety of epidural steroid injections.1 It was discovered that there were cases where complications such as loss of vision, strokes, paralysis, and even death did occur but the true incidence of these complications remained unclear during the research. The medical literature supports the view that these complications occurring after lumbar or cervical epidural space administration of corticosteroids are uncommon but were devastating if they occurred.
Factors that reduce the risk of complications include:
- Accurate placement of the needle in the affected area
- The administration of a non-particulate corticosteroid
- Making use of live fluoroscopy where the operator is familiar with contrast patterns of this technique.
- The use of digital subtraction angiography