Cervical or Thoracic Epidural Steroid Injection (ESI)
What is a cervical or thoracic epidural steroid injection?
An epidural steroid injection is a procedure in which your doctor injects steroid medication into the epidural space. The epidural space is located inside the bony spinal canal but outside the tube that holds the spinal fluid. It extends from the base of the skull to the base of the spine.
When a steroid (a strong anti-inflammatory medicine) is put into the epidural space, it can reach the spinal discs and nerves, reducing inflammation and relieving pain. The goal of a cervical or thoracic epidural steroid injection is to decrease neck or upper extremity pain caused by one or more compressed or inflamed spinal nerves in the neck (cervical spine) or middle back (thoracic spine).
Overview of the epidural steroid injection procedure
Here’s what to expect during an epidural steroid injection procedure:
- You will lie face down, with two pillows under your chest and a small pillow under your forehead.
- The injection area is cleaned and numbed before the injection.
- Using fluoroscopic (X-ray) guidance, your physician will determine the appropriate path for the needle.
- Your doctor inserts a thin needle into the appropriate region and enters the epidural space using a syringe.
- Next, your doctor injects a small amount of contrast dye to make sure that the medication will flow exactly where intended.
- Then, your physician injects a small amount of steroid into the epidural space.
- After the procedure, you’ll spend 10 to 15 minutes in the recovery area.
The steroid usually starts to work two days to two weeks after the injection. The pain relief varies for each individual, from no relief to long-term pain relief. Patients can have up to four steroid injections per year, depending on their other health problems or steroid injections into different areas of the body.
Preparing for the epidural steroid injection
- While the procedure may take less than 15 minutes, you should allow for at least 60 to 90 minutes at the procedure center.
- You need to arrange for a driver to be present and take you to and from the medical facility. If you do not have a driver with you, we may have to reschedule your procedure.
- If you are taking prescription blood thinners such as Coumadin (warfarin), Ticlid (ticlopidine), or Plavix (clopidogrel bisulfate), please inform your patient care coordinator. These medicines will need to be stopped before the procedure, but only after you receive permission from the doctor who is prescribing these medicines.
- If you develop a fever, night sweats, or an active infection before your procedure, your procedure will need to be rescheduled. Please contact our office at (651) 968–5201 immediately to let us know about the symptoms you’re experiencing.
Possible side effects of the steroid
Side effects of steroid injections are usually minimal and go away within one to three days after the procedure. Possible side effects of the steroid include:
- Facial flushing
- Fluid retention
- Low-grade fever (less than 100° F)
- For women, temporary changes to your menstrual cycle
- For people with diabetes, temporary elevation of blood sugar levels
After the injection
- Follow the specific instructions given to you by the nurses at the procedure center.
- Plan to rest for the remainder of the day. You may resume light activity that is comfortable for you, but do not overexert yourself the first day.
- You may be sore from the needle placement for one to two days. If a local anesthetic was injected, you may feel a numbing sensation in your arm for a few hours until the anesthetic wears off.
- For discomfort, apply ice packs to the puncture site for 15 minutes several times a day.
- Do not soak in a tub for 24 hours after the procedure. You may take showers.Report any signs of infection or other unusual symptoms to our office, including:
- Redness and warmth at the injection site
- Increasing pain
- Swelling or drainage at the injection site
- Chills, night sweats, or fever that reaches above 100° F
- If you develop a headache:
- Stay quiet with your head and body flat
- Drink plenty of fluids
- Take Tylenol (acetaminophen) or your prescribed pain medication
- If your headache lasts more than 12 hours or is noticeably worse when you stand up, it may be an indication of a spinal leak and you should notify our office. This is very rare and usually gets better without treatment.
- Keep a record of your pain and symptoms after the injection and report your results as instructed by your doctor’s patient care coordinator.
Remember that your usual pain may go away for a few hours, but after the local anesthetic wears off, it is normal for your pain to return. The full effects of the steroid may take two days to two weeks to work, and its lasting effects vary from person to person. You may also have some temporary discomfort at the puncture site.
Potential risks of epidural steroid injection
The risks of epidural steroid injection are minimal and are similar to any procedure involving a needle placement. These include, but are not limited to:
- Allergic reaction to the anesthetic, steroid, or contrast dye. Be sure to inform us before the injection if you have any known allergies.
- Needle injury to a blood vessel, which may bleed.
- Irritation of the injected area, which could cause temporary worsening pain.
- Inability to place the needle at the desired target, resulting in inability to complete the injection.
- Needle puncture of the spinal fluid tube, causing a spinal fluid leak. This could cause a spinal headache, and if not resolved by bed rest, may require specific treatment.
If your procedure includes sedation
- You should have no solid foods for six hours before your procedure.
- You may have clear liquids up to two hours before your procedure. Examples include:
- Clear fruit juices such as apple, cranberry, and grape juice (no pulp)
- Tea, black coffee with no cream
- Carbonated beverages
- Nothing by mouth, including throat lozenges, mints, and all hard candy, for two hours before your procedure.
- No gum for two hours before your procedure.
- You must have a responsible adult arrive with you to our facility and drive you home. If you use a taxi or volunteer ride service, you still must have a responsible adult with you in order to help take care of you after your procedure.
- Please take your regular medications the day of your procedure, especially any heart, diabetes, or blood pressure medications.
Summit Orthopedics offers comprehensive spine expertise
Summit’s spine care team is recognized by the National Committee for Quality Assurance for the comprehensive expertise of our patient-centered care. Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
More resources for you
- Visit our Spine Exercise Library for options to help ease neck and back pain
- See Summit’s treatment options for neck, back, and spine care
- Check out additional information on Summit’s approach to spine care
We asked Summit spine specialist Catherine Choi, M.D., to share her best tips for keeping your back and neck pain-free when working from home.
Meet the Expert: Doctor Bio Video Series
No matter what your age, doing this one simple thing can help keep your back pain-free for a lifetime.