Epidural Steroid Injections ; Do They Work?

In our practice,  we use Epidural Steroid Injections for both treatment as well as diagnostic purposes.  The research for these injections have been significant, but the conclusions by the various authors have been very different.   There continues to be controversy on the efficacy of the treatments, including the side effects versus the results.

Traditionally,  epidural steroid injections have been seen as a reasonable treatment option for patients with back pain and sciatica. Based on research and experience,  we use epidural steroid injections when a patient has a sciatic, or nerve inflammatory complaint.

Epidural steroid injections benefit the patient by delivering corticosteroids to the areas of inflammation.  The steroids have a known anti-inflammatory effect and will decrease the swelling to the tissues upon contact.  In a very simplistic way,  by decreasing the inflammation,  the affected nerves in the spine will be less irritated and therefore cause less pain.

Some practitioners also inject a volume of saline associated with the steroids and theorize that the volume of saline also flushes the area of painful chemicals that also lead to the inflammation.

For diagnostic purposes,  if the epidural steroid injections give even temporary relief,  it usually confirms that there is an irritant to certain nerves.  Based on temporary improvement, surgeons may consider the patient an appropriate candidate for surgery, as many practitioners use the so called transforaminal technique to try to isolate the specific nerve that may be causing the irritation.

There are certainly risks to the procedure, such as increased blood sugar, possible bleeding or infection, possible nerve injury. They should be done with x-ray guidance and any blood thinners or anti-inflammatories must be stopped at least 5 days before the injection.

Last modified: April 30, 2022