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Epidural Steroid Injections for Lumbar Spinal Stenosis

Examples

Generic Name
betamethasone
methylprednisolone
triamcinolone

How It Works

An epidural steroid injection (ESI) is a combination of a corticosteroid with a local anesthetic pain relief medicine. Corticosteroids are strong anti-inflammatory medicines. Relieving swelling and inflammation can take pressure off nerves and other soft tissues, which can relieve pain. The local anesthetic medicine helps give you immediate pain relief. Corticosteroid medicines take longer to have an effect.

Within the spinal canal, an ESI is injected into the space around the spinal cord and nerve roots (epidural space).

ESIs sometimes are used to treat pain and inflammation from pressure on spinal nerve roots. ESI is usually not tried unless symptoms caused by lumbar spinal stenosis have not responded to other nonsurgical treatment.

Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, are usually done before you are given the injection. These tests are used to identify the exact location where nerve roots are being squeezed. During the injection, an X-ray machine (fluoroscope) is often used to guide placement of the needle.

Why It Is Used

An epidural steroid injection (ESI) may be tried when other nonsurgical treatments have failed to relieve severe leg pain from lumbar spinal stenosis.

The corticosteroids in an ESI may help provide relief from leg pain by reducing swelling and inflammation. Local anesthetics help relieve pain but do not reduce inflammation. Lidocaine can also help relieve pain quickly, before the corticosteroid has taken effect.

How Well It Works

Lumbar spinal stenosis may cause pain that radiates from the lower spine to the hips or down the legs. Epidural steroid injections (ESIs) are used for leg pain rather than back pain from lumbar spinal stenosis.

Steroid injections may help relieve pain for a short time (2 to 3 weeks) in some people. Experts do not know how well injections work over longer periods of time.1

These injections may relieve symptoms and reduce inflammation but do not cure spinal stenosis.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • Pain and swelling around the injection site that lasts more than 2 days.

One common side effect of this medicine is pain and swelling the first day or two after the injection. It may help to apply ice at home for 15 to 20 minutes.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

If the steroid injection relieves your symptoms and your symptoms come back, your doctor may consider another injection. But steroid injections can damage soft tissues, so they are not given more than 3 or 4 times in a year in a single area.

A type of X-ray called fluoroscopy may be used to guide the needle placement for an epidural steroid injection.

The procedure usually takes less than 30 minutes. Then you are monitored for another 15 to 20 minutes before you go home. You will mostly rest on the day of the injection. Most people return to their normal activities the following day.

Your doctor will tell you what to watch for after you go home. Complications are rare, but can include infection, bleeding, nerve damage, and leaking of the fluid that surrounds the brain and spinal cord.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. North American Spine Society (2007). Diagnosis and treatment of degenerative lumbar spinal stenosis: Evidence-based clinical guidelines for multidisciplinary spine care. Available online: http://www.spine.org/Documents/NASSCG_Stenosis.pdf.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
Last Revised May 14, 2012

Last Revised: May 14, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics

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