Steroid injections have been used to treat back or leg pain since 1952. These injections often relieve sciatica and low back pain, especially if used in parallel with other medical recovery techniques.
Epidural injections with steroids (cortisone) can relieve pain in the neck, arm, back, and leg caused by inflamed spinal nerves. They may be recommended in conditions such as spinal canal stenosis, spondylosis, herniated disc, or sciatica.
The effect of the steroid injection can last from a week to a year, depending on the body of each patient. A steroid injection may be an option during an acute episode of back pain when other treatment methods do not work.
The FDA doesn’t approve these procedures, and they’re only considered temporary solutions rather than long-lasting treatments for chronic issues.
How much does an epidural steroid injection cost?
The cost of an epidural steroid injection will vary depending on your health insurance, location, and provider. Without coverage, it can range anywhere from $820 to more than $2,000 for just the procedure itself, with no other costs included like contrast dye injections, which can increase the total price quite a bit.
If your doctor wants to confirm that the injections will work for you, they may ask for a CT scan or MRI. This would be an extra expense in addition to what has already been spent on treatment.
MDSave.com gives you access to low-cost medical procedures in your area that are available on the website. For instance, providers listed at MdSave typically charge $920 for an epidural steroid injection.
According to Art Caplan, Ph.d., who is also a professor at Boston University School of Medicine and Health Sciences, an epidural steroid injection costs around $630 per shot.
Bottomlineinc.com states that the average injection costs between $620 and $2,600 each, with many medical professionals discouraging its use unless you have been experiencing back pain for over six weeks.
How and where are epidural steroid injections made?
Epidural steroid injections should only be given by doctors who specialize in medical recovery, anesthesia, imaging, neurology, and surgery. The doctor who will administer the injection will analyze the medical history and imaging investigations (x-rays, MRI) previously made to decide the best approach for this procedure.
In patients receiving anticoagulants (Coumadin, Heparin Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, high doses of aspirin), it may be necessary to stop taking these drugs 3-5 days before infiltration. Also, blood will be collected before the procedure to test the rate of blood clotting (PT-INR test, prothrombin time).
Studies have shown that the procedure done with fluoroscopy (X-rays) to guide the needle into the epidural space is more effective than infiltration without fluoroscopy guidance. The treatment typically lasts 15-30 minutes and is followed by a recovery period.
The patient may remain conscious during the procedure. Sedatives can be given to reduce the level of anxiety. Sitting face down on the table, the patient will be given a local anesthetic that will numb the area before the injection. If an intravenous sedative is used, blood pressure, pulse, and respiration will be monitored during the procedure.
With the help of a fluoroscope (a type of X-ray), the doctor will direct a needle through the skin and between the vertebrae to the epidural space. Fluoroscopy allows the doctor to follow the needle on the fluoroscope monitor in real-time, thus ensuring that cortisone treatment is given as close as possible to the inflamed nerve root. The patient will have a feeling of discomfort but in the form of pressure rather than pain.
Injection of the substance
When the needle is inserted, local anesthesia and cortisone are administered to the epidural space. Then the needle is retracted.
When do you need epidural steroid injections?
Epidural injections of steroids may be recommended for patients who experience pain in the neck, arm, lower back, or leg and suffer from the following conditions:
- Spinal stenosis – narrowing of the medullary canal and spinal nerve roots can cause back and leg pain, especially while walking.
- Spondylolisthesis is an anterior “slip” of a vertebra to the rest of the vertebrae and can press on the roots of the spinal nerves, causing pain.
- Disc herniation – the gelatinous substance inside the intervertebral disc or the hernia through a weakened area of the wall surrounding it can become inflamed (annulus fibrosus or fibrous ring). Irritation, pain, and inflammation are the effects that occur when the nucleus pulposus slips and comes in contact with the spinal nerves.
- Degenerative disease of the intervertebral disc consists of rupture or aging of the intervertebral disc, which causes a decrease in disc space, fissures of the annulus, and the development of osteophytes (beaks).
- Sciatica is a condition usually caused by compression of the spinal nerves, lumbar L5, or sacral S1. The pain is felt along the sciatic nerve, in the buttocks, and down on the legs.
Risks and side effects of epidural steroid injections
As with other invasive medical procedures, there are risks to which the steroid injection exposes the patient. In rare cases, steroid injections may have unwanted side effects. The main risk to which the patient is exposed when using steroid injections to treat low back pain is infection. In less than 1% of cases, the infection occurs as a result of such a medical procedure.
Then, there is a risk that the needle will touch a nerve or a blood vessel, causing temporary or even permanent damage.
Post-epidural headaches can also occur in 0.5% of cases. This means that the patient is dealing with a severe headache immediately after performing the procedure, which usually improves in a few days.
In addition to the risks to which the patient is exposed, there are a number of side effects such as:
- pain in the place where the medicine is injected;
- fever the night after the medical procedure;
- high blood sugar;
- stomach ulcer;
- severe hip arthritis;
Important things to consider
Most patients can move immediately after the intervention, being able to resume their usual activities the next day. Mild painkillers and ice packs can relieve pain at the injection site.
In patients with various associated pathologies, it may be necessary to be under observation on an outpatient basis over the next 7-10 days to monitor the symptoms and effect of cortisone injections.
For patients whose pain decreases substantially in intensity, no further procedures or surgery will be necessary. Patients who do not notice an improvement after epidural injections of steroids will discuss the next steps of treatment with their doctor.