Epidural Injections and Back Pain

John De Angelis, M.D.

An epidural block is an injection of medication into the epidural space (an area around your spinal cord.) It may be performed in any one of four areas of the spine. A cervical epidural is performed in the neck. A thoracic epidural is performed between the shoulder blades. A lumbar epidural is performed in the low back region and a caudal epidural is performed near the tailbone. An MRI or CT Scan is almost always needed before an epidural injection. Every attempt is made to find the spinal abnormality responsible for your pain. The MRI is a tool which frequently leads to the discovery of the etiology or cause of the pain.

Several painful conditions respond well to epidural steroids including the following:

• Disc “ruptures”
• Spinal joint pain
• Degenerative discs
• Spinal narrowing
• Spinal fractures
• Shingles

As with all invasive medical procedures, there are potential risks associated with epidural steroid injections. Generally, however, they do not occur frequently. Radiofrequency risks do not occur frequently. Minor infections occur in 1% to 2% of all injections. Severe infections occur in 0.1% to 0.01% of injections. Bleeding complications are rare. Nerve damage can occur from direct needle trauma or secondarily from infection or bleeding. Paralysis is rare, but it has been reported. Most severe spinal cord injuries have occurred in the cervical and thoracic region when the injection area was severely narrowed and/or when the patient was overly sedated during needle placement.

Side effects from steroids are not uncommon and include the following:

• Headache
• Blood sugar increase
• Muscle cramps
• Avascular necrosis
• Cataracts
• Face flushing
• Chest flushing
• Moon-like face
• Increased appetite
• Hiccoughs (rare)
• Water retention

Epidural steroid injections are often an effective non-surgical alternative for spine pain. Research has demonstrated a benefit from epidural steroid injections. Approximately 60-75% of patients receive some relief from steroid injections. Benefits include pain relief, improvement in the quality of life, reduction in the use of pain medications, preservation of work activities, less hospitalization time and a lessening of the need for surgical intervention.

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