Epidural Steroid Injections with Dr. Wheeler


We don’t go straight to cutting.

This is one of the most common and recurring reasons patients choose Oasis Orthopedic & Spine as a partner in their journey to find pain relief. We are committed to exploring non-surgical options before considering a surgical treatment (and even then, we suggest minimally invasive procedures. Here’s why). One of the most prevalent and popular non-surgical pain relief treatments available at Oasis is epidural steroid injections.

We caught up with Dr. Ralph Wheeler, our pain management and diagnostic radiology specialist to learn the ins and outs of epidural steroid injections.

What is an epidural steroid injection?

Dr. Wheeler:“An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.”

Who can benefit from an epidural steroid injection?

Dr. Wheeler:“Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with spinal stenosis, spondylolisthesis, herniated disc, degenerative disc, or sciatica.”

  • Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
  • Spondylolisthesis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, it can compress the nerve roots causing pain.
  • Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
  • Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
  • Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

Who performs epidural steroid injections?

Dr. Wheeler:“Physicians who perform epidural steroid injections include physiatrists (PM&R), radiologists, anesthesiologists, neurologists, and surgeons.“

How do epidural steroid injections work?

Dr. Wheeler:“A steroid injection includes both a corticosteroid (e.g., triamcinolone, methyl-prednisolone, dexamethasone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the bony vertebra and the protective dura sac surrounding the spinal nerves and cord.”

“Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves by flushing away the proteins that cause swelling. The pain relief can last from days to years, allowing your spinal condition to improve with physical therapy and an exercise program.”

Is any preparation required? Is any anesthesia used?

Dr. Wheeler:“The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions at this appointment.”

“Patients who take blood thinning medication (Coumadin, Plavix, etc.) may need to stop taking it several days before the ESI. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.”

“The procedure is usually performed in an outpatient center using x-ray fluoroscopy. Make arrangements to have someone drive you to and from the center the day of the injection.”/p>

“Local anesthesia (numbing medicine) is always used during an epidural steroid injection. Patients that are extremely anxious about the procedure may receive conscious sedation administered by a qualified anesthesiologist.”

What are the risks and side effects of epidural steroid injections?

Dr. Wheeler:“With few risks, ESI is considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, and nerve damage.”

“Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).”

Are epidural steroid injections painful?

Dr. Wheeler:“A local anesthetic is injected into the skin, numbing the area where the epidural needle is then placed. Patients may experience mild discomfort but should not experience severe pain during the procedure.”

Why get an epidural steroid injection as opposed to surgery?

Dr. Wheeler:“Some patients receive sufficient pain relief from epidural steroid injections to the level of not requiring surgery. If a patient does not receive adequate pain relief from an epidural steroid injection, surgery may be an alternative.”

Is there a limit to how many epidural steroid injections you can receive?

Dr. Wheeler:“There is no definitive research to mandate the frequency of how often you should have these injections. In general, it is considered reasonable to perform up to three epidurals within a 6-month period of time. In certain cases, a 4th epidural can be performed in the following 6 months.”

“Although it is safe to give occasional steroid injections, there can be cumulative negative systemic effects on the bones (osteoporosis) and adrenal glands from too much steroid annually.”

COVID-19 has changed our daily lives. Social distancing and quarantining has impacted how we get our healthcare. The important thing to remember is that you have options. Oasis Orthopedic & Spine offers telehealth appointments in addition to in-person appointments.

We are dedicated to your safety during COVID-19 and are actively practicing the COVID-19 Safe Care Protocol at all of our locations so you can find the pain relief you deserve no matter what is going on in the world.

If you think epidural steroid injections could be the solution to your pain, request your free in-office or telehealth consultation today.