Benefits, Procedure, and Risks
Imagine your leg is on fire – a constant, torturous throbbing from your lower back all the way down to your calf. Even the slightest movement is agonizing. Painkillers provide little relief. You can’t work, can’t exercise, can’t even tie your shoes without wincing in agony. For the millions who suffer from severe sciatica, this is their daily reality – a ceaseless fight just to function. But what if a simple injection could extinguish the flames?
Epidural steroid injections are quickly becoming the nonsurgical treatment of choice for stubborn sciatica cases unresponsive to medication and physical therapy. This cutting-edge technique delivers powerful anti-inflammatory medicine directly into the epidural space around inflamed nerves.
While not a permanent cure, research reveals these targeted injections can provide long-lasting sciatica relief when all else fails. With new advances in imaging and needle insertion, epidural steroids are transforming lives once shattered by sciatic nerve pain. But is it right for you?
Sciatica refers to radiating pain along the path of the sciatic nerve, which originates from nerve roots in the lower spinal cord at lumbar segments L4, L5, S1, S2, and S3 before running down each leg. Irritation or compression of the lumbar nerve roots can cause inflammation and pain signals to be sent down the sciatic nerve, felt most prominently in the buttocks and backs of the legs.
Patients with sciatica typically experience moderate to severe, sharp, shooting pain from the low back down the back of one thigh and the outer side of the calf and foot. Numbness, tingling sensations, and muscle weakness may also occur along the affected nerve pathways. Pain and other symptoms are usually more severe in one leg, as it is rare for both sides of the sciatic nerve to be compressed.
What Causes Sciatica?
Sciatica is most commonly caused by a herniated or bulging disc in the lumbar spine pressing on the nerve roots. Other spinal conditions like spinal stenosis, degenerative disc disease, spondylolisthesis, and piriformis syndrome can also irritate or compress the sciatic nerve, leading to similar symptoms. Sciatica is more likely to develop in those with physically demanding jobs and is increasingly common with aging.
Getting an accurate diagnosis is important, as symptoms similar to sciatica can also be caused by other conditions like peripheral neuropathy or vascular claudication. Careful patient history, physical examinations, and medical imaging can help confirm a diagnosis of sciatica stemming from the lower back. Early diagnosis and treatment is key to addressing inflammation and preventing worsening of symptoms.
What is an Epidural Steroid Injection?
An epidural steroid injection (ESI) is a minimally invasive procedure that delivers steroid medication directly into the epidural space surrounding the spinal cord and nerve roots. This is done by inserting a needle through the back into the epidural space, under guidance from live x-ray called fluoroscopy.
Once the needle is positioned, a mixture of long-lasting corticosteroid (commonly dexamethasone or methylprednisolone) and local anesthetic is slowly injected. The anti-inflammatory steroid spreads around the epidural space and nerve roots, helping reduce inflammation that may be causing pain and irritation. The local anesthetic provides temporary, short-term pain relief.
ESIs are most commonly performed in the lower back, known as lumbar epidural steroid injections, to target nerve roots that form the sciatic nerve. Other types include cervical and thoracic epidural injections, which deliver medication around nerves in the neck and mid-back regions. Lumbar ESIs are one of the most frequently performed interventions in pain management clinics.
The primary goal of epidural steroid injections is to reduce local inflammation, which can help relieve pain and support healing of conditions like herniated discs or spinal stenosis. ESIs are not intended to permanently cure spinal conditions or serve as stand-alone long-term treatment, but rather to provide pain relief as part of a more comprehensive treatment plan.
Benefits of Epidural Steroid Injections for Sciatica
When performed by an experienced clinician, epidural corticosteroid injections offer several potential benefits for patients with lumbosacral radiculopathy and sciatica:
|More immediate pain relief than oral medication
|Patients often experience significant reduction in leg and back pain within 1-2 days after the epidural injection. Local anesthetics provide temporary numbness while steroids begin working on inflammation.
|Sustained pain relief
|Steroids may provide weeks to months of pain relief as inflammation is reduced around compressed spinal nerves. Some patients experience long-term remission of symptoms.
|Avoidance of surgery
|Effective ESIs allow some patients to manage their condition through more conservative treatments and avoid riskier surgical interventions like discectomy.
|Improved physical function
|Reduction of pain enables patients to participate more easily in exercise and physical therapy programs to improve mobility.
|Decreased reliance on oral pain medication
|Patients may be able to reduce usage of prescription or over-the-counter analgesics for pain management.
|Non-surgical pain management
|ESIs are considered a minimally invasive treatment option as part of conservative care before considering major back surgery.
|Treatment of acute flare ups
|ESIs can quickly address increases in pain and inflammation associated with aggravations of sciatica.
It is important to note that the benefits of ESI can vary greatly depending on the patient’s condition, response to the medication, and the technical skills of the treating physician.
Getting an epidural steroid injection follows a relatively straightforward process, though the procedure does require specialized medical training. It is typically performed in an outpatient setting or physician’s office. Here is a general overview of what patients can expect:
- Initial consultation: The doctor will discuss your medical history, examine you, and review imaging tests to determine if an ESI is appropriate for your condition.
- Positioning: You will be positioned lying on your stomach, with a pillow under your abdomen to arch your lower back. This opens up the spinal column and spreads the vertebrae.
- Cleaning and local anesthetic: The injection site on your low back is cleaned and local anesthetic applied to numb the insertion site.
- Fluoroscopic guidance: The fluoroscopy x-ray machine allows the placement of the needle to be viewed on a live monitor.
- Needle insertion: Once adequately numb, a thin needle is inserted through the back and into the epidural space around the spinal nerves.
- Contrast injection: Contrast dye may be injected and visualized to confirm proper needle placement before the medication is administered.
- Steroid injection: The steroid and anesthetic medication mixture is slowly injected into the epidural space.
- Removal and bandage: The epidural needle is carefully removed and a bandage applied to the injection site.
The actual ESI procedure typically takes less than 10 minutes, although you should plan for up to an hour including preparation, positioning, and recovery time. Some soreness at the injection site is common afterwards. Most patients can resume normal activity the next day, though strenuous activity is restricted for a couple days.
Risks and Adverse Events
Epidural steroid injections are generally considered safe, with adverse side effects being uncommon when administered by an experienced physician. However, as with any medical procedure, potential risks include:
- Increased pain – Some patients experience worsening nerve pain for a few days following the injection before feeling relief.
- Bleeding or bruising at the injection site
- Headache as a result of dural puncture and leaking spinal fluid
- Nerve damage or spinal cord injury from improper needle placement – Rare with fluoroscopic guidance
- Infection – Rare serious complication, estimated 1 in 100,000 to 200,000 procedures
- Abscess formation – Very rare with proper sterile technique
- Allergic reaction to the steroid or anesthetic medication
- Elevated blood sugar levels in diabetic patients from the steroid
- Facial flushing, insomnia, and other hormone-related side effects from the steroid
When to Consider Epidural Steroid Injections
Patients with sciatica or radicular pain should consider speaking with their doctor about whether epidural steroid injections may be helpful in their case. In general, ESIs are most appropriate for:
|Patients still experience significant radicular pain after 4 – 6 weeks of conservative treatment like rest, therapy, and oral medication. Chronic nerve compression is unlikely to improve spontaneously.
|Severe pain limiting daily function and quality of life. Difficulty participating in exercise or physical therapy programs.
|Pain from an acute disc herniation or flare up of sciatica. ESIs deliver faster relief than oral steroids.
|As an alternative to spinal surgery, or to provide relief while waiting for surgery.
Conversely, epidural injections may provide little added benefit for milder cases of spinal nerve root irritation that respond adequately to more conservative treatments. Other pain generators like muscle strain may be better addressed with other therapies.
Patients experiencing persistent sciatica or lumbar radiculopathy should have an informed discussion with their healthcare provider about whether epidural steroid injections may be a helpful option in their individual case, as part of a multidisciplinary pain management approach.
As a telemedicine platform that connects patients with top specialists, Kaly can help those struggling with chronic back and leg pain explore whether procedures like ESIs are appropriate to discuss with their doctor or pain management specialist. By getting an expert opinion, Kaly offers convenient access to personalized care plans incorporating the most advanced pain management options available. Sign up for Kaly today to get started.