Epidural Steroid Injections
The nerves that the brain uses to communicate with the arms and legs travel encased in the bony spinal column. These nerves can get irritated in the spinal column from mechanical or chemical irritation. Epidural steroid injections can deliver medications that reduce pain and irritation in the epidural space.
Epidural steroid injections come in many different types. Types are differentiated by location and approach. The location is in relation to the area of the spine being addressed. The spine has five different areas, the cervical, thoracic, lumbar, sacral, and coccyx, of which only the first four areas are utilized as routes of administration into the epidural space. Cervical is the neck. Lumbar is the area commonly referred to as the back, at the waist. Thoracic is the area between the cervical and lumbar or between the shoulder blades, and sacral is the area below the lumbar or commonly referred to as the tailbone. The approaches are interlaminar and transforaminal; these are fancy terms for directly from the midline of the back and from the side, respectively. Interlaminar epidural steroid injections deliver a high volume, low concentration of medicine to a large, general area, whereas transforaminal epidural steroid injections delivers a low volume, high concentration of medicine to a small, specific area.
During the procedure, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area, is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the area of interest of the spine is identified and the skin is anesthetized. Using a small needle, the epidural space (the area where the painful nerves are located) is entered using fluoroscopic guidance. Local anesthetic (numbing medications) and steroid is injected at the desired location. The patient may feel pressure as the medicine is injected. The patient’s back may have some discomfort where the needle was inserted over the next few days, but this will resolve. The steroid takes approximately 48-72 hours to have full effect, where as the local anesthetic wears off in approximately 8-12 hours. Please allow three days to assess the efficacy of the procedure.