Epidural steroid injections (ESIs) are a frequently used treatment for certain chronic pain conditions. Some common conditions treated with ESIs are: low back pain, neck pain, and pain radiating down an arm or leg. Pain arising from a spinal nerve root and traveling down an arm or leg is often referred to as "radicular pain".
Some conditions commonly treated with Epidural Steroids include:
- Degenerative Disc Disease
- Postlaminectomy Syndrome
- Spinal Stenosis
- Herniated Discs
The goal of the procedure is to place medication into the epidural space of the spine. The injection consists of a combination of a local anesthetic (Lidocaine or Marcaine) and an anti-inflammatory medication (Depomedrol or Celestone). The anti-inflammatory medications work by decreasing inflammation around the nerve root and usually take 3-5 days but may require longer to provide relief. The medicine then spreads throughout the epidural space encompassing many other levels of the spine. The entire procedure usually takes less than fifteen minutes.
The most important and greatest success achieved with the use of epidural steroid injections (ESI) is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this, help patients regain the ability to resume their normal daily activities.
There are several techniques to place the medication into the epidural space. The type of pain and the anatomy of the spine will determine how the epidural space can be safely accessed.
Different routes of access to the epidural space include:
- Interlaminar Injection: With this approach, the needle enters the midline of your back. The medication is then injected and spreads to both sides of the spine.
- Transforaminal Injection: With this approach, the needle is inserted into the side of the spine with the target site where the nerve root exits the bony portion of the spine (neural foramen). This approach is useful for discrete nerve root pain or if the midline approach is not feasible for reasons such as the existence of scar tissue after surgery.
- Caudal Injection: With this approach, the needle enters the epidural space by your tailbone. This technique allows a larger volume of the medication to be delivered.
ESIs could be given in the neck, mid and lower back.
The amount and duration of pain relief vary from person to person and are dependent on many other factors, including underlying pathology and activity level. Some can have relief that lasts for years, while others have short-term relief. It is important to discuss your response to epidural steroids with your physician in order to plan future treatment options.