Steroid injections are a non-surgical treatment option utilized for relieving neck, back and extremity joint pains. Spine conditions such as herniated disc, spinal stenosis and many others may induce back pain due to the compression of the associated spinal nerves. This pain or numbness may extend to the other parts of the body such as hips, buttocks, and legs. Doctors start with non-surgical methods to treat joint pain and steroid injections are one of these preferences. In cases where the patient finds no relief from non-surgical methods then finally surgery is recommended.
The injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as epidural anesthesia given before child birth to decrease labor pain. The injections are administered into the epidural space of the spine or into the affected extremity joint space. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5 mm wide and is filled with spinal nerve roots, fat and small blood vessels.
Steroid injections may be employed both for diagnostic and therapeutic reasons, including:
- Medications to determine the specific nerve root involved in the spinal problem (diagnostic purpose)
- Medication for inducing short or long-term relief from pain and inflammation (therapeutic purpose)
It is to be noted that steroid injections are not a curative intervention, rather it’s a treatment tool to reduce the discomfort of the patient.
Pain management in different conditions such as spinal stenosis, disc herniation, arthritis, shoulder, hip and knee pain can be achieved through steroid injections. Different types of physicians such as physiatrists, anesthesiologists, radiologists, neurologists, and surgeons may recommend steroid injections for pain relief.
Usually steroid injections are administered on an outpatient basis. The procedure involves the following steps:
- Patient is taken to the pre-op area where trained nursing staff prepares the patient for the procedure by taking vitals and reviewing medications. Blood sugar and coagulation status may also be checked if needed.
- Patient is taken to the procedure room and positioned appropriately.
- The injection site is then cleansed, and an injection of a local numbing agent may be given in the area so that you don’t feel pain during the procedure.
- A thin hollow needle is then inserted into the epidural space or affected joint space while being guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle on a monitor for the surgeon to view.
- When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine or joint space.
- Finally, the needle is removed, and the injection site is covered with a dry, sterile bandage.
Patients may feel some pressure during the injection but mostly the procedure is painless. The procedure takes about 15-30 minutes to complete. After injection, the patient should not drive or go back to work and should rest and avoid any vigorous activities. Your surgeon may give specific post-care instructions. Please follow the instructions to recover faster.
Patients may feel numbness in the arms or legs just after procedure along with other side effects related to the anesthetic component that usually settles down within 1-8 hours. Patients may continue to feel some pain, as epidural spinal injections take about 24-72 hours before showing their pain-relieving action. In some cases, if the desired effect is not obtained, then reinjection may be recommended. The standard guidelines for steroid injections state a maximum of 3 injections per year. In case no relief is obtained from the injections, then surgery is considered as the final option.
Risks and complications
With any procedure some risk factors will always be there. Likewise, steroid injections have complications such as bleeding or infection at the injection site, pain during or after injection, post-injection headache, nerve injury, bladder dysfunction, fluid retention, respiratory arrest, epidural hematoma, and spinal cord infarction. Discuss with your doctor if you have any concerns prior to the procedure.