Epidural Steroid Injections

An epidural injection delivers a mixture of steroid and anaesthetic directly into the epidural space in your lower back (lumbar spine). Epidural injections are an effective, non-surgical option for treating spinal nerve irritation, sciatica and lower back pain. Download fact sheet (PDF) »

  • During the Procedure

    As with many spinal injections, an epidural injection is best performed CT for guidance to properly target and place the needle (and to help avoid nerve injury or other injury).

    The injection procedure consists of the following steps:

    • The patient lies face down on a CT table and the skin over the area to be treated is well cleaned.
    • The physician numbs a small area of skin with an anaesthetic (a numbing medicine). This may sting for a few seconds.
    • The physician uses CT guidance to direct a very small needle into the epidural space. Several drops of contrast dye are then injected to confirm that the medicine is in the right area.
    • A small mixture of anaesthetic and anti-inflammatory medication (cortisone) is then slowly injected into the epidural space.

    The injection itself only takes a few minutes, but the entire procedure usually takes between fifteen and thirty minutes. After the procedure, the patient typically rests in the waiting area for twenty to thirty minutes, and then is asked to move the area of usual discomfort to try to provoke the usual pain.  On occasion, the patient may feel numb or experience a slightly weak or odd feeling in the upper back or legs for a few hours after the injection. On the day of the injection, patients are advised to avoid driving and avoid doing any strenuous activities.

    The patient should record the levels of pain relief during the next week in a pain diary. Tracking the level of pain is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed.

  • Preparation

    You will need to make an appointment for this examination and will also need to arrange a driver. You may eat and drink as you wish before and after the procedure.

    Please advise our receptionists if you take any blood thinning medication or medication to prevent stroke.  It is very important that we are advised of any medication that you are currently taking, including antibiotics, when you make your appointment with us.  In some cases you may be require a blood test before the procedure.

    You will be asked to sign a consent form prior to the procedure.

  • After the Procedure

    On the day of the injection, patients are advised to avoid doing any strenuous activities, unless instructed by their doctor. The patient should not drive the day of the injection unless approved by the treating physician. If sedation was used, the patient should not drive for 24 hours after the procedure. Patients may notice a slight increase in pain lasting for several days as the numbing medicine wears off and before the cortisone starts to take effect. If the area is uncomfortable in the first two to three days after the injection, carefully applying ice or a cold pack to the general area of the injection site will typically provide pain relief.

    Patients may continue to take their regular pain medicine after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate.

    On the day after the procedure, patients may return to their regular activities. When the pain has improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid recurrence of pain.

    If the first block procedure is effective in alleviating the patient’s back pain, it is often considered reasonable for the procedure to be repeated up to three times per year if needed. However, if the first epidural injection does not relieve the patient’s pain then the injection should not be repeated.

  • Potential Risks and Complications

    As with all invasive medical procedures, there are potential risks and complications associated with epidural injections. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from Epidural injection are the following:

    • Allergic reaction. Usually an allergy to X-ray contrast or steroid; rarely to local anaesthetic
    • A rare complication, bleeding is more common for patients with underlying bleeding disorders.
    • Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
    • Worsening of pain symptoms
    • Discomfort at the point of the injection
    • Nerve or spinal cord damage or paralysis. While this is extremely rare, damage could possibly occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery-causing blockage.

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