Epidural steroid injections (ESIs) are a frequently-used, non-surgical approach to treat neck, mid-back, and low back pain that radiates into the arms, ribs, abdomen, or legs. Radiating pain is often caused by inflammation and irritated nerve roots from the spine, which causes pain along the nerve root in varying distribution into the arms or legs. These irritated nerve roots may also be associated with numbness, tingling, and/or weakness. ESIs are used to inject local anesthetic and steroid medications into the epidural space, which surrounds the discs and spinal nerves. The steroid medication reduces the inflammation and irritation along the affected nerve roots and discs. Epidural steroid injections are commonly used in conditions such as degenerative disc disease, spinal stenosis, herniated or bulging discs, sciatica, spondylosis, radiculitis, and radiculopathy
Multiple evidence-based studies show epidural injections to result in significant improvement in acute and chronic pain conditions. The procedure allows rapid pain relief of symptoms that grants patients significant restoration in function and mobility, while minimizing their need for medications to control their pain. There are several types of epidural steroid injections, so your physician will determine which type is most appropriate for you based your pain syndrome and needs.
- Transforaminal ESIs: This epidural has been shown to be the most effective approach for lumbar conditions, but can also be performed in the cervical and thoracic spine. This technique places the medication, a steroid and anesthetic solution, along the side of the vertebrae above the opening for a specific exiting nerve root. In the cervical and thoracic spine, this technique is often used to give diagnostic information regarding which nerve root and level in the spine is causing the most pain and is often performed at a single level on one side. In the lumbar spine, the procedure is typically performed at two levels of the spine: at the affected nerve root and disc, as well as the level below, as the medication will flow upward to treat the posterior aspect of the affected disc more effectively. The procedure typically takes less than 15 minutes.
- Interlaminar ESIs: This type of epidural is typically used in cervical and thoracic conditions, but can be effective in the lumbar conditions as well. This injection is performed in a midline approach at a single level of the spine, between the spinous processes of two vertebrae. Once the needle is positioned in the epidural space, the physician injects a mixture of steroid and anesthetic solution, spreading the medication along the affected nerve roots and discs. The entire procedure typically takes less than 5 minutes.
- Caudal ESIs: This type of epidural is less commonly performed, as transforaminal epidurals are typically more effective for low lumbar pain; however, the caudal technique has been shown to be effective, particularly for pain originating from the sacrum or tailbone. This approach places the medication in the epidural space above the tailbone, where a large volume of treatment solution in the form of steroid and anesthetic medication is placed.
Epidurals are most successful in providing long-term pain relief when the procedure is coupled with therapy and a daily home exercise program. The amount and duration of pain relief experienced by patients varies from individual to individual, however. It often depends on the severity of pain condition involved. Studies have found that epidurals do have successive improvement in treating pain as the procedure is repeated, with most patients have the greatest pain relief between the second and third epidural. Because of this, your treating physician will likely recommend multiple ESIs.
ESIs are considered a safe, non-surgical treatment for patients suffering from neck and back pain. The procedure is one of the most common procedures performed in pain management. The most common potential risks include bleeding, infection, post-dural headache, and nerve damage. The potential side effects of the steroid medications include elevated blood sugar levels, disrupted sleep, altered mood, stomach ulcers and transient decrease in immune function. Patients that are on blood thinners, have an active infection, are immunosuppressed, or are pregnant should consult with their physician before receiving the procedure.