Back and Neck Pain Treatment: Epidural Steroid Injections
The type of condition that epidural steroid injections treat is radiculopathies, or pinched nerves coming from the neck or low back. If a disc is herniated or protruded, it can push on a nerve and cause spine pain. Therefore, sometimes people will get numbness, pain or tingling in the extremities. Sometimes they’ll get the full spectrum, sometimes only get part of the spectrum, so the epidural steroid injection really helps us reduce the inflammation and therefore reduce the back and/or neck pain associated with the condition.
An epidural steroid injection is done under fluoroscopic guidance or X-ray guidance, meaning live X-ray. What we do is place the needle right around the nerve that we suspect is causing the spine pain, and we give a little bit of dye, or contrast, to outline that nerve root to make sure we’re in the right spot before we ever inject anything. Then we give the medication for back pain relief.
Patients often have a little bit of anxiety beforehand, but our nurses do a great job of walking the patients through. Patients come in for about 10-15 minutes before the procedure – our nurses take their vitals, talk to them and do an assessment on them. We bring them back into the fluoro suite for the X-ray, lay them down on the table facing downwards, prep the area and keep everything nice and sterile. Initially they’ll feel a little bit of a stick – a burn – that’s usually the numbing agent that anesthetizes the area. Then we use the needle under X-ray to make sure we’re in the right spot before we ever inject anything. We give a little bit of dye, it outlines the nerve root we’re looking for, and then we give the medication. After the procedure, the patient is taken back to the room. They’ll be there for another 10-15 minutes to make sure their blood pressure and everything is ok. We give them post-op instructions. The patients usually follow up two weeks after the procedure.
The advice I have for patients considering epidural steroid injections is that it really is a safe procedure if done correctly. We really do take into consideration what is the pain generator. We also take into consideration what other treatments they’ve had before. If they really are a good candidate for an epidural steroid injection, we go over the risk and complications. After the injection, really for 2-3 weeks, we like the patients to take their time and not overdo it at all. On follow-up, 2-3 weeks after the injection, we discuss what is the next step. If they’re doing a lot better, then usually we’ll release them to physical therapy to continue a core stabilization program. If they’re not experiencing back or neck pain relief, then it’s time to consider referral to a spinal surgeon.