Epidural steroid injections (ESI) are a method of treating inflammation which is associated with neck related arm pain or low back related leg pain. In these conditions the spinal nerve becomes inflamed because the passage where the nerves travel as they pass down or out of the spine become narrow.
Epidural steroid injections contain corticosteroid and an anesthetic numbing agent. The reason of using corticosteroid is that it can reduce inflammation and can be really effective when delivered directly into the painful area.
Conditions in which epidural steroid injections are useful:
- Spinal stenosis
- Herniated disc
- Degenerative disc
Epidural steroid injections procedure:
There are three common methods for delivering steroids into the epidural space; the interlaminar, caudal, and transforaminal approaches.
All three approaches are using a method of placing a thin needle into position by using fluoroscopic guidance. Before the injection, contrast dye is used to confirm that the medications are travelling into the desired area or not. Local anesthetic is often added with the steroid to provide temporary pain relief.
- Interlaminar epidural steroid injections referred as an ‘epidural injection’. It involves placing the needle into the back of the epidural space and delivering the steroid over a wider area.
- Caudal approach uses the small boney opening which is present just above the tailbone, called as sacral hiatus, to allow for needle placement into the very bottom of the epidural space.
- During transforaminal epidural steroid injections, which are commonly referred as a ‘nerve block’, the needle is placed alongside the nerve as it exits the spine and medicines are placed into the nerve sleeve. And the medications then travel up the sleeve and into the epidural space from the side.
All three approaches usually take 15- 45 minutes to complete, followed by a recovery period. Many patients can get relief after one injection but if you experience only mild pain relief then one to two more injections may be performed in 1-4 week intervals to achieve full effect.
Risks associated with epidural steroid injections:
- Spinal headache
- Allergic reaction
- Nerve damage
- Weight gain
- Water retention
- Mood swings or insomnia
- Elevated blood sugar levels in people with diabetes
Zaki Anwar MD is an Anesthesiologist and Interventional Pain Management Specialist. His center has broad command on the diagnosis and treatment of back pain, headaches, migraines, neck pain, sciatica pain and various pain conditions.
For further queries call on 815.412.6166