EPIDURAL STEROID INJECTION

Sapiens Hospital Care Package: Treatment for back and neck pain caused by degenerative spine conditions, slipped discs, compressed nerves, and cervical spine degeneration.

Article by Dr.Nattaya Udomsakdi (พญ นาตยา อุดมศักดิ์)

What is an Epidural Steroid Injection (ESI)?

For patients experiencing neck pain radiating down the arm (cervical radiculopathy) or back pain radiating down the leg (lumbar radiculopathy) caused by a herniated disc, studies show that these symptoms often improve on their own within 4 to 6 weeks.

For patients without muscle weakness, initial conservative treatment with oral medication and/or physical therapy is recommended. However, if the pain is severe enough to interfere with daily life, an epidural steroid injection directly targets and reduces localized inflammation caused by chemical mediators around the cervical or lumbar nerve roots, providing significantly faster and more noticeable pain relief.

Mechanism of Action of Epidural Steroid Injections

Corticosteroids are powerful anti-inflammatory medications that suppress the inflammatory molecules released by a damaged or herniated disc. These chemicals irritate and inflame nearby nerve roots, which is recognized as the primary cause of pain—often playing a larger role than physical nerve compression itself. In fact, pain severity does not always correlate directly with the size or position of a disc herniation; a compressed nerve root may cause weakness or numbness without severe pain, while chemical irritation can cause intense pain. These inflammatory substances can also stem from conditions such as spinal stenosis, spondylolisthesis, scoliosis, or vertebral compression fractures.

Beyond its anti-inflammatory effects, steroids also act directly on nerve fibers to reduce pain signal transmission.

Studies show that most spine-related pain can resolve on its own with conservative measures like oral medication and physical therapy. However, when these treatments are insufficient, epidural steroid injections offer a targeted next step—relieving pain, helping patients resume normal activities faster, and reducing the need for surgical intervention:

• Lumbar Disc Herniation: For patients without neurological weakness, 56% to 60% experience significant pain relief, successfully avoiding surgery.
• Spinal Stenosis: Approximately 59% of patients experience sustained pain relief lasting up to a full year. Injections can be repeated if the goal is to prevent surgery or postpone it until a patient is ready.
• Cervical Epidural Steroid Injections: Injections in the neck region have been shown to reduce the need for surgery by up to 80%.

Administering steroid injections early in the course of symptoms yields significantly better clinical outcomes than delaying treatment until the condition becomes chronic over several months.

How Often Can Steroid Injections Be Administered?

There is no definitive consensus on the exact frequency, but it is generally recommended not to exceed 2 to 4 times per year as clinically necessary. The benefits and potential risks must be carefully evaluated by a specialist before each procedure.

Self-Care Guidelines to Prevent Recurrence

• Avoid Known Triggers: Refrain from heavy lifting, improper or overly strenuous workouts, and quit smoking.
• Maintain a Healthy Weight & Core Strength: Focus on core-strengthening exercises to stabilize the spine, such as swimming, Pilates, the McKenzie method, Yoga, Tai Chi, or traditional wand exercises.
• What to Do If Pain Persists After 2 Weeks of Injections and Consistent Exercise
• If pain does not improve, offers only short-term relief, or if distinct muscle weakness develops, consultation with a spine orthopedic surgeon is recommended to address the underlying nerve compression surgically.

Important Surgical Consideration: If spine surgery is required, it should be scheduled at least 1 month after an epidural steroid injection to minimize the risk of postoperative infection.

References

• Luis RV, Emiliano NV, Juan ES Henao 3, Gustavo G. UPDATE ARTICLE
• LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia (English Edition) ,Volume 45, Issue 1, January 2010, Pages 17-22
• Min Soo Lee ,Ho Sik Moon. Safety of epidural steroids: A review. Anesth Pain Med 2021;16:16-27
• Neil A. Manson, Melissa D. McKeon and Edward P. Abraham. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series. CAN J SURG April 01, 2013 56 (2) 89-96;
• Chang Liu, Giovanni EF, Christina AS, et al.. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ Clinical Research 381:e070730 (Published 19 April 2023)
• Martin John Wilby, et al.. Microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation. Lancet Rheumatol 2021; 3: e34756
• Steven P. Cohen, Emileigh Greuber, Kip Vought and Dmitri Lissin. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain. Clin J Pain. 2021 Sep; 37(9): 707717.
• Gregory S Kazarian, Michael E Steinhaus, Han Jo Kim. The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis. Global Spine Journal. 2022 Sep; 12(7):1524-1534.
• Josh L, Nolan G, John C, et al. Results of cervical epidural steroid injections based on the physician referral source. Interventional Pain Medicine.Volume 1, Issue 1, March 2022
• John P. K, Jayme C.B. Koltsov, Matthew WS, et al. Cervical epidural steroid injections: incidence and determinants of subsequent surgery. The Spine Journal Volume 20, Issue 11, November 2020, Pages 1729-1736
• Van Boxem K, Rijsdijk M, Hans G, de Jong J, Kallewaard JW, Vissers K, van Kleef M, Rathmell JP, Van Zundert J. Review article : Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group. Pain Pract. 2019 Jan;19(1):61-92.