The main reason to get an epidural injection is temporarily reduce the pain. In our opinion epidural injections are not effective for spine conditions, they carry a huge risk and other methods such as Orthopaedic Medicine are much safer and results last.
What is an epidural injection?
Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain (we think old fashioned and not effective). The goal of the injection is pain relief; however this is just temporary relief and does not deal with the causes just symptoms, meaning pain will reoccur.
We think the risks are high:
- Infection. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
- Dural puncture (“wet tap”). A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days. Although infrequent, a blood patch may be necessary to alleviate the headache. A blood patch is a simple, quick procedure that involves obtaining a small amount of blood from a patient from an arm vein and immediately injecting it into the epidural space to allow it to clot around the spinal sac and stop the leak.
- Bleeding. Bleeding is a rare complication and is more common for patients with underlying bleeding disorders.
- Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the needle, or from infection or bleeding.
Side Effects: Lumbar Epidural Steroid Injection
As with all invasive medical procedures, there are potential risks associated with lumbar epidural steroid injections. In addition to temporary numbness of the bowels and bladder, the most common potential risks and complications include:
- Localised increase in pain
- Non-positional headaches resolving within 24 hours
- Facial flushing
- Fever the night of injection
- High blood sugar
- A transient decrease in immunity because of the suppressive effect of the steroid
- Stomach ulcers
- Severe arthritis of the hips (avascular necrosis)
We think the risks and side effects are not worth taking with epidural injections, instead it is better to utilise a non-invasive safe method of approach (based on Orthopeadic medicine and 45 years of clinical experience) such as decompression.