Epidural Steroid Injection (ESI)

Your referring physician has requested that you have an epidural steroid injection. The following is a description of the procedure and a description of the potential complications, so that you may provide informed consent prior to the procedure.

An epidural steroid injection (or ESI) is an invasive procedure with some uncommon risks. After local anesthesia (numbing medicine) is injected, a needle will be placed with fluoroscopic (x-ray) guidance into the spine along the fibrous sac that contains spinal fluid and nerve roots. A small amount of contrast (x-ray dye) will be injected to confirm correct needle placement. Then an injection of steroids will be made into the same location. You will then be monitored for potential complications in the hospital for a short time after the procedure (usually about 30 minutes) until you are discharged. You will be able to eat and drink as well as use the bathroom while in the hospital after the procedure. Most complications of epidural steroid injections are rare and the procedure is very safe. You need to know the potential complications, which include:

1. BLEEDING: As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood thinners such as Coumadin or Plavix, bleeding complications are extremely rare. Rarely, patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after spinal needle procedures like epidural injections.
2. INFECTION: Any needle passing through the skin can introduce infection, so there is a rare risk of infection such as meningitis. Meningitis is an extremely rare complication, and sterile technique will be used during the procedure to minimize this risk.
3. SPINAL HEADACHE: Spinal headache may occur if a small hole is made in the fibrous sac that contains the spinal fluid and nerve roots, and that hole does not close completely. The spinal fluid inside can then leak out, and if the leak is significant, the brain loses the cushioning effect of the spinal fluid which causes a severe headache when you sit or stand.  These small holes are only made in less than 1% of epidural injections and usually heal on their own.  Spinal headaches typically they occur about 1-2 days after a procedure.  These headaches are usually very positional, meaning they start when you sit or stand and go away when you lie down.  If you develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill, do not have a fever, and the headache goes away when you lie down, you may treat yourself 24 hours of bed rest only getting up to go to the bathroom and by drinking plenty of fluids. Caffeine often helps with these headaches as well, if your doctor normally allows you to have caffeine. These simple actions almost always work. If it does not, please contact the radiologist who performed the procedure.  Uncommonly a procedure, called an epidural blood patch, may be performed in the hospital that has a very high success rate in treating these spinal headaches that don’t resolve with bedrest.
4. STEROID SIDE EFFECTS: Epidural steroids may rarely produce unwanted side effects. Some of these potential side effects include increased blood sugar or hyperglycemia (especially in diabetic patients), fluid retention, elevated blood pressure, and transient redness or facial flushing. (Side effects from steroids are more common if they are taken daily over a length of time, rather than as an isolated epidural injection.)
5. ALLERGIC REACTION: The use of any medication, including x-ray contrast, has the possibility of producing an allergic reaction.  Please inform your physician of your known medical allergies before the procedure.

Please feel free to ask any questions you may have about the procedure prior to signing the consent form.