Some people suffer spinal injuries when they are injured in motor vehicle collisions or slip and fall accidents, including herniated discs, bulging discs, and other injuries that can cause chronic, radiating back pain. One type of treatment that might be recommended for chronic back pain caused by spinal injuries in an accident is epidural injection. Epidural injections are one type of nonsurgical treatment that can be used to manage pain caused by injuries to the spinal discs. However, these injections offer both benefits and risks and are generally not the first-line treatment. Here is some information about epidural injections following an accident that you should know.
What Are Epidural Injections?
Epidural injections are injections of steroid medications and local anesthetics that are made directly into the epidural space that surrounds the spinal nerve roots and the spinal cord following injuries to the spine. These injections are commonly used to manage back pain and sciatica. The injections help to control pain and inflammation that arises from one or more vertebral segments involved with movement.
There are several goals of epidural steroid injections, including the following:
- Reduce inflammation around the nerve roots to control pain
- Improve functioning and mobility in the back and legs
- Facilitate progress in the patient’s physical therapy and rehabilitation program
Epidural steroid injections are typically not recommended until after several other nonsurgical treatments have been tried but haven’t worked, including medication and physical therapy. They are often tried before surgery will be considered.
When Might Epidural Steroid Injections Be Recommended?
Epidural steroid injections are commonly used to treat inflammation and irritation of the spinal nerve roots and their associated back and leg pain. Some of the types of conditions that might be treated with epidural injections include the following:
- Herniated discs
- Degenerative disc disease
- Spinal stenosis
Localized back pain and leg and back pain that occurs while walking are less commonly treated with epidural injections.
Doctors that administer epidural steroid injections include pain management and spine specialists, including anesthesiologists, physiatrists, neurologists, spinal surgeons, and radiologists. The injections might be given in hospitals, surgery centers, or outpatient clinics.
Potential Benefits of Epidural Steroid Injections
Epidural injections might offer benefits when someone is experiencing acute back pain caused by injuries to the vertebral column and nerve inflammation. The primary drawback of epidural injections is that they are not always effective. When they are, the relief from the pain will be temporary and last from one week to up to a year. If the initial injection is effective, you might receive up to three subsequent injections during a year.
Epidural injections might offer the following benefits to people who are suffering from chronic, acute back pain and sciatica following an accident:
- Reduction of inflammation and nerve pain by decreasing the body’s production of inflammatory agents and reducing the nerves’ sensitivity to pain
- Reducing the dependence on and need for pain medications and the side effects they can cause when taken on a long-term basis
- Allowing sufficient pain relief so that you can continue physical therapy and make progress
- Postpone surgery and potentially eliminate the need for it by making progress in physical therapy more effective
How Epidural Injections Are Provided
Epidural injections might be given using several different techniques. Each of these techniques is described below.
In the transforaminal technique, the doctor will administer the steroid directly into the epidural space in the area in which the nerve is likely to be inflamed. The transforaminal technique targets the specific nerve roots to control pain and inflammation.
The interlaminar technique involves inserting the needle through the back and depositing the medication into the epidural space. It is not as precise as the transforaminal approach because it doesn’t target specific nerve roots. Instead, the steroid medication can spread throughout the epidural space.
This approach to an epidural steroid injection is the easiest to administer and is considered to be safer. The caudal approach might be used to control diffused or widespread pain. This involves injecting the steroid medication into an opening of your sacral bone in the lower back and might be used if you suffer from lower back pain and sciatica.
The particular route your doctor might choose depends on your diagnosis, the results from previous treatments you have received, and your doctor’s skill and experience.
Types of Steroids That Might Be Used
The steroids that might be used in your epidural injections might vary based on their particulate size, water solubility, and whether they clump together.
Steroids that are not water soluble are called particulate steroids. They have larger particles that might clump together and deposit at the site of the inflammation or nerve compression for a long period. They might offer long-term pain relief. Some examples of particulate steroids that might be used in an epidural injection include methylprednisolone and triamcinolone.
Non-particulate steroids dissolve in water and have smaller particle sizes. The particles will not clump together and typically remain in the epidural space for a shorter time. An example of a water-soluble steroid that might be used is dexamethasone.
How Effective Are Epidural Steroid Injections?
A majority of patients report that they experience pain relief from epidural injections lasting from a week up to a year. If you have a good response to an initial injection, your doctor might recommend a second injection when your improvement starts to wan. In most cases, no more than three injections will be given in 12 months. While epidural steroid injections might offer short-term benefits, they might not offer long-term effectiveness for pain relief. Additional research needs to be conducted to determine the long-term effectiveness of epidural steroid injections for the relief of pain following spinal injuries caused by accidents.
Potential Risks of Epidural Injections and Their Contrainidcations
While epidural steroid injections are considered to be minimally invasive and relatively safe, they also carry some risks. Some of the temporary side effects you might experience following an epidural injection include the following:
- Pain at the injection site
- Facial flushing
In most cases, these side effects will resolve within a few hours. Some of the serious potential complications include the following:
- Dural puncture – Accidental insertion of the needle through the dura mater that covers the spinal cord, causing cerebrospinal fluid to leak out
- Nerve damage – Damaging nerves resulting in loss of sensation, seizures, or abnormal sensations and could cause cauda equina syndrome and potential paralysis
- Heart complications – Might cause a decreased heart rate and low blood pressure
- Anesthetic risks – If the mixture contains local anesthetics, the anesthetic could be toxic to the central nervous system if it enters the bloodstream
- Steroid risks – Particulate steroids might clump together and form blockages in the blood vessels
Fortunately, the risks of serious complications are relatively rare. They tend to be higher in injections that are administered above the third lumbar vertebra. The most common risk occurs in people over age 50 when steroids are accidentally injected into a blood vessel. In rare cases, people might suffer allergic reactions to the steroid, anesthetic, or contrast dye.
Injections that are administered at the fourth lumbar vertebra or below carry lower risks.
The injections will typically not be given if you suffer from any of the following medical conditions:
- Bleeding disorders
- Uncontrolled diabetes
- Heart conditions
Process of Administration
When you go to the doctor for an epidural injection, you might be administered an IV medication to relax you. However, you will likely remain conscious during the procedure. The area of your back where the injection will occur will be numbed with an injection of a local anesthetic. This helps the injection procedure to be relatively painless.
The process of injecting epidural steroids typically only takes around 30 minutes. You might experience pressure, mild burning, or tingling when the medication enters your epidural space. The discomfort and irritation will typically disappear within a few minutes following the injection. You will likely be allowed to return home after a few hours and will be told to follow some precautions for a few days.
The first line of treatment for spinal injuries following an accident is normally physical therapy and medications. However, if these more conservative treatments don’t work, your doctor might recommend epidural steroid injections as an alternative to surgery. Make sure you understand both the potential benefits and risks of getting epidural steroid injections before you agree to undergo this procedure. While they do pose some risks, they might help you to postpone your need for back surgery or potentially avoid it altogether.