Epidural Steroid Injections
Epidural steroid injections (ESIs) are a common treatment option for many forms of spine and limb pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
Epidural steroid injections deliver medication directly (or very near) the source of pain generation. In contrast, oral steroids and painkillers have a more generalized impact and may have unacceptable side effects. Additionally, if the pain stems from chemical inflammation, an epidural steroid injection will help control this local inflammation.
Steroids inhibit the inflammatory response caused by chemical and mechanical sources of pain. Steroids also work by reducing the activity of the immune system to react to inflammation associated with nerve or tissue damage.
Epidural steroid injections (ESIs) are used for discogenic and radicular pain from the cervical, thoracic, and lumbar spine. ESIs are used for the following: disc herniations, spinal stenosis, spondylosis or arthritic conditions of the spine resulting in radiculitis or referred symptoms.
Other uses include the treatment of pain from post-surgical conditions, post-herpetic or post-traumatic (including intercostal) neuralgia, muscle contraction headaches, or from a sub acute inflammatory spine pain syndromes unresponsive to more conservative treatment.
It may be necessary to have several epidural injections in a series over a period of a few weeks to maximize the benefits. It is not uncommon to have two or three lumbar epidural injections, each about ten days apart.
Spinal epidural shots can be done several ways:
Cervical: ESIs are usually focused at the lower levels of the cervical spine and the steroid washes upwards over the cervical nerve roots.
Caudal: the injection is placed through a small opening (sacral canal) just above the tail bone and the steroid washes up the lower lumbar nerve roots bilaterally.
Interlaminar: the injection is usually midline and placed directly between two vertebrae (similar to the approach a woman undergoes during labor for epidural anesthesia).
Transforaminal: the injection is placed in the foramina (opening) on the side of the spine near the exiting nerve.
Injections may be done, but with caution, for patients with certain conditions such as
Allergies to the injected solution
Uncontrolled medical problems such as renal disease, congestive heart failure and diabetes.
Patients on high doses aspirin or other anti-platelet drugs (e.g. Ticlid, Plavix), are at risk of bleeding from the procedure. These medications are usually stopped prior to having an injection, under the guidance of the physicians. Contra-indications:
Several conditions maybe considered a contra-indication from having an injection:
Local or systemic infection
Pregnancy (if fluoroscopy, a type of X-ray, is used)
Bleeding problems – patient taking blood thinners (Coumadin, etc.), or patients with a bleeding problem (hemophilia, etc.)
Recovery from these shots is fairly quick, within 48 hours and improvements can last from several weeks, to months and even years.