Epidural steroid injections aim to relieve inflammation and painful symptoms originating in the spine due to chronic conditions of vertebral discs. Herniated or damaged discs often cause irritation or compression of spinal nerve roots, causing painful swelling. The injections serve to reduce inflammation of the epidural space, where nerve roots may be compressed, causing back pain and nerve malfunction. This type of pain management may be used as a regular therapy on its own or be used to alleviate pain enough to allow a patient to exercise in physical therapy sessions effectively.
Pain may originate from discs of three general regions of the spine; the cervical (upper back/ neck area), thoracic (mid-back area), or lumbar (lower-back area) portions. Three different types of epidural steroid injection are used to address problems that originate in each of these areas.
CERVICAL EPIDURAL STEROID INJECTION
A cervical epidural steroid injection is a diagnostic and therapeutic procedure for pain that originates in the neck and radiates down the arm. The cervical region of the spine consists of seven vertebrae and the soft discs between them that offer support for movement. There are a couple types of cervical epidural steroid injections that differ in where they are inserted into the epidural space:
- Cervical Interlaminar Epidural Steroid Injection – The needle enters the epidural space from the back of the spine.
- Cervical Transforaminal Epidural Steroid Injection – The needle enters the side of the epidural space.
THORACIC EPIDURAL STEROID INJECTION
A thoracic epidural steroid injection is a procedure used for diagnosing and treating pain of the middle portion of the back. The mid-back section of the spine has 12 vertebrae, separated by soft discs and is surrounded by nerve roots. The spine has a protective covering called the dura that shields all these components. Pain may arise from several factors in the epidural space. There are a couple types of thoracic epidural steroid injection that differ only in where the needle enters this epidural space.
- Thoracic Interlaminar Epidural Steroid Injection – The needle enters the epidural space from the back of the spine.
- Thoracic Transforaminal Epidural Steroid Injection – The needle enters the side of the epidural space.
LUMBAR EPIDURAL STEROID INJECTION
Lumbar epidural steroid injections are used to diagnose and treat chronic pain in the lower back and extremities. The lumbar portion of the spine consists of five vertebrae and surrounding nerve branches and ligaments. Soft discs provide a cushion between each vertebra for more comfortable movement. The whole system is covered by the dura, and the area surrounding it is called the epidural space. There are a few types of lumbar epidural steroid injections which vary only in where the needle is positioned.
- Lumbar Interlaminar Epidural Steroid Injection – The needle enters the epidural space from the back of the spine.
- Lumbar Transforaminal Epidural Steroid Injection – The needle enters the side of the epidural space.
- Lumbar Caudal Epidural Steroid Injection – The needle enters through an opening in the tailbone. This is the easiest, most common lumbar epidural steroid injection.
CAUSES OF PAIN
Epidural steroid injections effectively treat pain caused by damaged discs. This affects the epidural space, making injections to this area very helpful in relieving the inflammation caused.
- Discs may tear, causing fluid to leak out and irritate the nerves and dura. This would cause the nerve root and dura to inflame.
- The disc itself could swell, causing a bulging disc.
- Bone spurs, called osteophytes, may form on the vertebrae, compressing nerve roots.
DIAGNOSIS
When conservative methods of treatment, including ice, anti-inflammatory medications and physical therapy, fail to relieve pain, an epidural steroid injection may be recommended. X-rays and MRIs may be effective in showing a disc bulge or nerve compression, but torn and leaking discs are not visible. For this reason, an epidural steroid injection may also be used as a diagnostic test. If the epidural steroid injection relieves the pain, then the doctor can determine that a leaky or torn disc is present. It can then be used as treatment for the pain for any of the possible causes.
PREPARING FOR THE PROCEDURE
- Arrange a ride home after the procedure.
- Plan to rest for the remainder of the day.
- Discuss all medications with your doctor beforehand.
THE PROCEDURE
The patient may first receive an IV medicine to help the muscles relax. The target area is then sterilized and a long, thin needle is inserted. The doctor is guided by fluoroscopy, which is x-ray imaging that helps determine the path the needle is to follow. Medications will then be injected, including a local anesthetic to numb the area and a corticosteroid that will provide long term anti-inflammatory relief. The patient will be monitored for 30 minutes following the epidural steroid injection and should be able to return to work the following day.
RESULTS
The pain will immediately be relieved for a few hours, but return within a few days. This is because the injection site may be sore and the corticosteroid will not activate for a few days following. The duration of pain relief depends on the individual. For some, one injection can provide long term pain relief. For others, treatment may be needed every few months. This depends on underlying problems or causal conditions and how severe they may be. A doctor usually will not inject a patient more than 3 times in 6 months, given the adverse effects of regularly using steroids.
RISKS
As with any injection, there is very slight risk of infection or bleeding after an epidural steroid injection. Very rare cases of nerve injury have been reported. Soreness of the injection site will occur, but can be treated with over the counter pain relievers such ibuprofen. The corticosteroid may increase blood sugar in some patients.
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