Epidural steroid injections for lumbar spinal stenosis

Examples

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Brand Name	Chemical Name
Celestone Soluspan	betamethasone acetate

Brand Name	Chemical Name
Depo-Medrol	methylprednisolone acetate

Brand Name	Chemical Name
Aristospan	triamcinolone hexacetonide

How It Works

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An epidural steroid injection (ESI) is a combination of a corticosteroid with a local anesthetic pain relief medicine. Corticosteroids are strong anti-inflammatory medications 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 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 that result from pressure on the spinal cord caused by lumbar spinal stenosis and that 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 or while you are being given the injection. These tests are used to identify the exact location where nerve roots are being squeezed.

Why It Is Used

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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

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Lumbar spinal stenosis may cause pain that radiates from the lower spine to the hips or down a leg. 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 50% 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

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ESIs should be used with caution. This treatment only relieves symptoms for a short time, and the long-term effects are not well studied.

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

• Back pain and tenderness where the injection was given for about 2 to 4 days.
• 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

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

Epidural steroid injections 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

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Truumees E, Herkowitz HN (2001). Lumbar spinal stenosis: Treatment options. AAOS Instructional Course Lectures, 50: 153–161.

2. Isaac Z, et al. (2005). Lumbar spinal stenosis. In WJ Koopman, ed., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2087–2092. Philadelphia: Lippincott Williams and Wilkins.

3. Nasca RJ (2002). Lumbar spinal stenosis: Surgical considerations. Journal of Southern Orthopaedic Association, 11(3): 127–134.

Credits

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Author	Amy Fackler, MA
Author	Ralph Poore
Editor	Sydney Youngerman-Cole, RN, BSN, RNC
Associate Editor	Michele Cronen
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	March 7, 2006