FAQ’s on Epidural Steroid Injection
What is an Epidural Steroid Injection?
Patients with symptomatic pains in one or more of their limbs due to a compressed or pinched nerve may be able to achieve pain relief through an epidural steroid injection. The epidural space is the empty space surrounding a patient’s spinal cord, and is where the spinal nerves are located. Inflammation in this area can be a serious concern as it can potentially compress or pinch a nerve, affecting the functionality of a limb while causing debilitating pain for patients.
By injecting a steroidal supplement into the epidural space of the spine, patients will receive direct medication for the inflammation that is most often the source of nerve complications.
What will an Epidural Steroid Injection treat?
Almost any condition of the limbs that is resulting from a spinal nerve that has been pinched or compressed can have relief provided to it with an epidural steroid injection. Among the most common of causes of pain for patients is a nerve that has been affected due to an affliction of a spinal disc, such as when a disc becomes herniated or is bulging. Damaged discs can affect any spinal nerve they are in close proximity to, as discs will swell to pinch or compress surrounding nerves. The effectiveness of an epidural injection of herniated discs has been researched and confirmed as a reliable treatment (A randomized, double-blind, active-control trial of the effectiveness of lumbar interlaminar epidural injections in disc herniation, 2014).
Afflicted nerves can produce conditions such as sciatica (pain and numbness in the legs), radiculopathy (pain in the neck), or directly cause pain in the lumbar back (lower back). There are other conditions in which an epidural steroid injection can be effective which include cases where degenerative disc disease has caused damage, if arthritic inflammation is compressing the nerve, or if a patient has severe enough spinal stenosis where the nerves become affected.
The effectiveness of an epidural injection in treating lumbar pain has been clinically studied and confirmed as a reliable treatment (Clinical effectiveness of single lumbar transforaminal epidural steroid injections, 2013), with the effectiveness of injection studied for discogenic pain confirmed in recent trials (A randomized, double-blind, active-controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain, 2013).
How is an Epidural Steroid Injection performed?
An epidural steroid injection is performed by our clinic as an outpatient procedure requiring only local anesthetic at the area to be injected. Patients desiring full sedation may request it. Patients will be asked to lie prone so that the physician may access their spine. The needle to be used will be guided with fluoroscopic imaging, which is a collection of X-rays taken in very quick succession to create a real-time image of where the needle is located.
There are three primary methods of injection that an epidural can be given as:
A Transforaminal Injection: Focus is placed on a direct injection into the structure housing the nerve root, called a neural foramen. This allows for direct placement of the medication next to the afflicted nerve, accelerating the rate at which medication takes effect.
A Caudal Injection: Focus is placed on the base of the spine, with many patients receiving their injection into the sacrum. Caudal injections receive the largest amount of medication, which is allowed to move through the epidural space with natural means. This method of injection is capable of treating multiple nerve roots, and is one of the most common medication delivery methods used.
An Interlaminar Injection: Focus is placed on using a “loss of resistance” technique to place the needle into the area of the epidural space with the less resistance, where medication will be injected near the nerve root.