Epidural Steroid Injections

• 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.