Epidural steroids

Research studies have shown the benefit of epidural steroid injections for sciatica and back pain caused by spinal disc lesions.

The purpose of the injection is to carry the medicine to the inner part of the back where some of the types of more serious strain affecting the discs, can cause pressure on, or irritation of, the nerves. The solution bathes these structures with anti-inflammatory steroid to reduce swelling and pain.

The solution contains a mixture of local anaesthetic or normal saline and corticosteroid. It may be injected just above the tail-bone (the caudal route) or between the bones in the small of the back (the lumbar route)or similar route in the lower cervical spine. The injection can be performed safely without the need for overnight stay or general anaesthetic. X-Ray guidance will be used with contrast enhancement to aid accuracy.

In the majority of cases it is not a particularly painful procedure although you may experience some feeling of pressure as the volume of fluid is injected, or your sciatic pain may worsen temporarily. After the procedure you will be expected to rest for a while (20 minutes or longer) before going home.

You may experience some numbness around the pelvis or buttocks, temporary light headedness and slight unsteadiness in the legs if local anaesthetic has been used. For this reason you should not drive a vehicleor operate machinery until the next day.

The benefit may appear almost immediately or build up gradually over the next few weeks. It is extremely unlikely that you will experience any other significant side effects.

Because of the corticosteroid component some women develop a facial flush the next which lasts 12-24 hours and more rarely some disruption of the menstrual cycle for one or two cycles. Other possible complications are similar to those of any injection and are very rare, namely infection and allergic reaction which can occur in approximately 1 in 7,000 cases and can be dealt with promptly. Rarely mid line injection scan cause haematoma which could need urgent surgical decompression.

There is no clear evidence of any long term complication from epidural steroids.

Caudal Epidural Injection

By feeling just above the tail bone the doctor identifies the lower entrance to the spinal canal at the base of the sacrum.

The needle enters the spinal canal through a ligament. The anaesthetic and steroid solution is then injected slowly over a period of some minutes. The solution spreads up the canal to reach the level of the third lumbar vertebra or higher.