Pioneer Spine and Sport Physicians, Spine Surgeons, East Longmeadow, Greenfield, Northampton, West Springfield, Lenox, MA » Spine » Spine Procedures » Lumbar Epidural Cortisone Injections

Lumbar Epidural Cortisone Injections

Pain in the lower back and legs can develop following injury to the spine or as a result of aging and disc degeneration. When this pain is severe, it may be associated with the release by the body of certain chemicals which cause inflammation and swelling. This inflammation often can be decreased simply by rest and common medications such as aspirin or Advil. If the inflammation persists despite these treatments, cortisone may be recommended.

Cortisone (a type of steroid) is a very powerful anti-inflammatory medication. It can be administered as pills taken by mouth or with an injection. When administered by injection, the cortisone is maximally concentrated at the site of inflammation and higher doses are possible with improved effectiveness.

An epidural injection places the cortisone in the space around the spinal nerves (epidural space). Once injected, the cortisone is slowly released into the surrounding tissues and decreases inflammation, swelling and pain. The cortisone does not cure the underlying cause of your pain. The goals of the injection are to decrease pain to a tolerable level and to allow you to participate in rehabilitation and therapy while natural healing occurs. It commonly takes 7-10 days for the cortisone to be fully effective. One injection may produce a dramatic relief of symptoms. Sometimes a second or third injection is required in order to obtain the maximum benefit. More than four injections in a year are not recommended.

THE PROCEDURE

The injection is performed as an outpatient. The injection takes about 15 minutes to perform. You will be either on your stomach or on your side. Your back will then be washed with iodine. Then the skin at the injection site is numbed with local anesthetic. A needle is then inserted into the epidural space. The position of the needle is checked using a special X-Ray machine, and by injecting a contrast agent into the epidural space. Once the needle is correctly positioned the cortisone is injected. Most patients experience very little pain either during or after the injection. After the injection you will be gradually mobilized up to standing and walking. The nurse will review discharge instructions with you. A friend or relative should be with you or available to bring you home.

RISKS AND SIDE EFFECTS

Epidural cortisone injections are very safe and usually have no side effects. There are, however, certain potential risks with which you should be familiar. Some patients experience a mild ache in their back several hours after the procedure when the local anesthetic has worn off. This usually resolves rapidly and can be treated with an ice pack for 15 – 20 minutes and/or Tylenol. Allergic reaction to either cortisone, contrast agent (iodine), or local anesthetic (xylocaine) is very rare. If you think you may be allergic to any of these medications, you must notify your doctor. Patients occasionally experience slight lightheadedness after the procedure. Less common side effects include transient headache, nausea, facial flushing, insomnia, and low-grade fever.

Complications from placement of the needle are rare. A small leak of spinal fluid can occur as the needle is placed into the epidural space. Usually, the leak stops spontaneously and does not cause any problems. It can, on occasion, cause a headache which worsens when you sit up. Most often this can be treated at home with bed rest and fluids. On rare occasions a procedure to stop the fluid leak is needed. Infection, bleeding, and nerve damage have been reported but are very, very, rare.

Epidural cortisone injection should not be performed if you have active infection at the site of injection, a bleeding disorder, or uncontrolled diabetes or congestive heart failure.

Relax! Most patients find that undergoing an epidural cortisone injection is much easier than they had imagined. If you have additional questions, please ask your doctor.

POST INJECTION INSTRUCTIONS

  • Rest at home for the remainder of the day following the injection. Don’t tackle any big projects. If you do experience aching in your back, try an ice pack for 15 – 20 minutes or some of your usual pain medication such as Tylenol. If you develop a headache you should rest in bed the next day and drink plenty of fluids. If it persists, contact your doctor.
  • The day after your injection, you may resume normal activities. But remember not to push beyond your limits.
  • Contact your doctor or the emergency room if you develop signs of infection (fever or redness at the site of injection), or if you notice a change in the way the nerves in your arms or legs are working (increasing numbness or weakness) or a change in your bowel or bladder function.

Pre and Post Instructions

Pre-Procedure Instructions:

  1. You will need to be driven home from the procedure so make appropriate arrangements.
  2. Notify your provider at Pioneer Spine and Sports Physicians if you would like medicine to help you relax during the procedure.
  3. Relax! Most people expect spinal procedures to be worse than they are.
  4. The following medications are “blood thinners” of one sort or another and must be avoided before the procedure:

    Aspirin

    Aspirin and all aspirin containing medications (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin, Pentasa, and others) – Stop 7 days prior to your procedure.

    All medications listed below should be stopped 3 days prior to your procedure:

NSAIDs (NON STEROIDAL ANTI-INFLAMMATORIES)

  • Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
  • Choline salicylate (Arthropan)
  • Diclofenac potassium (Cataflam)
  • Diclofenac sodium (Voltaren, Voltaren XR)
  • Diclofenac sodium with misoprostol (Arthrotec)
  • Diflunisal (Dolobid)
  • Etodolac (Lodine, Lodine XL)
  • Fenoprofen calcium (Nalfon)
  • Flurbiprofen (Ansaid)
  • Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
  • Indomethacin (Indocin, Indocin SR)
  • Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
  • Magnesium salicylate (Arthritab, Bayer Select, Doan’s Pills, Magan, Mobidin,
  • Mobogesic)
  • Meclofenamate sodium (Meclomen)
  • Mefenamic acid (Ponstel)
  • Nabumetone (Relafen)
  • Naproxen (Naprosyn, Naprelan)
  • Naproxen sodium (Aleve, Anaprox)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)
  • Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex,
  • Salsitab)
  • Sodium salicylate (various generics)
  • Sulindac (Clinoril)
  • Tolmetin sodium (Tolectin)

This is a partial list. If you are unsure whether you are taking an NSAID, please call us.

Please notify our office if you are on any of the medications listed below. These will probably need to be held for several days prior to your injection.

  • Warfarin (Coumadin)
  • Acenocoumarol
  • Heparin
  • Low molecular weight heparin: Enoxaparin (Lovenox)
  • Dalteparin
  • Fondaparinux
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
  • Cangrelor
  • Dabigatran
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Edoxaban
  • Abciximab
  • Eptifibatide
  • Tirofiban

Post-Injection Instructions

  1. Rest at home for the remainder of the day following the injection. Don’t tackle any big projects. If you do experience aching in your neck or back, try an ice pack for 15-20 minutes or some of your usual pain medication such as Tylenol or Advil.
  2. The day after your injection you may resume normal activities but remember not to push beyond your limits.
  3. A follow-up appointment should have been scheduled before your procedure. If it was not scheduled, be sure to do so at the time of your procedure.
  4. Contact your doctor or the emergency room if you develop signs of infection (fever or redness at the site of injection), or if you notice a change in the way the nerves in your arms or legs are working (increasing numbness or weakness) or a change in your bowel or bladder function.

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