Epidural steroid injections for lumbar spinal stenosis

Examples

Generic Name	Brand Name
betamethasone acetate	Celestone Soluspan
methylprednisolone acetate	Depo-Medrol
triamcinolone hexacetonide	Aristospan

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 used to 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). The injection does not go into the membrane (thecal sac) that contains the spinal cord and nerve roots.

ESIs sometimes are used to treat pain and inflammation from pressure on the spinal cord. 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), computed tomography (CT) scan, or X-rays, may be 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 can 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 a leg. Epidural steroid injections (ESIs) are used for leg pain rather than back pain from lumbar spinal stenosis.

Severe pain that has started recently is sometimes called "acute pain." About half of people receiving corticosteroid injections for acute pain get relief that lasts from a few weeks to a few months.¹ Some people get enough pain relief that they can delay or no longer need surgery.²

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

Side Effects

Epidural steroid injections (ESIs) should be used with caution. This treatment may only relieve symptoms for a short time, and the long-term effects are not well studied. Most experts recommend that no more than 3 ESIs be given in a 12-month period.

If side effects occur, they are usually minor and may include:

• About 2 to 4 days of back pain and tenderness where the injection was given.
• Feeling sick to your stomach and sometimes vomiting.
• Dizziness.
• Headache.

More serious side effects are very rare, but can include bleeding, infection, nerve root injury, and meningitis.

People who have an increased risk for infections, such as those with diabetes or those with immune system problems, may be at a higher risk for problems from ESIs. People with mental health disorders may also have a higher risk for problems from this treatment.

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

What To Think About

Epidural steroid injections (ESIs) should not be given if there is any sign of infection.

ESIs may only relieve symptoms for a short time, and the long-term effects are not well studied. Talk with your doctor about the risks related to the number of ESIs you expect to get.

If lumbar spinal stenosis is caused by a congenitally (from birth) small spinal column, rather than by osteoarthritis or another degenerative bone or joint condition, corticosteroid injections may increase symptoms, such as pain and numbness.³

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Author:	Shannon Erstad, MBA/MPH	Last Updated: February 21, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics
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