Epidural Steroid Injection (ESI) is a method of treating/ relieving pain from the nerve inflammation due to disc herniation and / or narrowing of the passages where the nerves travel as they come out of the spine. Those passages are called neural foramen. Epidural steroid injection is performed by using a mixture of corticosteroids and a local anesthetic which are injected into an epidural space. Epidural space is the space that surrounds the spinal sac and is filled with fatty tissue. Local anesthetic is used in order to “reset” the pain threshold of the inflamed nervous tissue (almost like resetting one’s “jammed” computer) and steroids are used due to the fact that they possess a very potent anti-inflammatory action. All of that is designed to break the vicious cycle of pain-inflammation-pain.
Spinal epidural steroid injection is performed with imaging guidance (fluoroscopy) with the help of a portable x-ray machine and by using radiocontrast material. Use of the x-rays insures the proper placement of the needle in relationship to the bony structures / anatomical landmarks and use of contrast material insures proper flow of the medications to be injected. Multiple pictures are made from different angles since this is truly a three dimensional science.
The best candidates for the spinal epidural steroid injection are patients that suffer from so-called radicular pain/ pain radiating down one of the extremities (i.e. sciatica). This condition usually arises from mechanical irritation of the nerves by any nearby anatomical structures: disc bulge/ herniation, spinal stenosis, spondylolisthesis (slippage of one vertebral body in relationship to the one below).
Those injections are an elective type of minimally invasive procedures which are performed in the outpatient setting, most commonly right in the doctor’s office. Usually, patients can return to their everyday activities the very same day. The patient should have two waves of pain relief: immediately after the procedure due to the function of the local anesthetic, followed by the 2nd, delayed wave about ~24-48 hours later due to action of corticosteroid.
Injection therapy is commonly combined with other treatment modalities (medications, chiropractic adjustments, physical therapy, acupuncture, etc.) in order to maximize the improvement/benefit and to prolong the effects.
Patients scheduled for the procedures in our office are asked to bring a driver with them and are asked not to drive after the procedure. It is recommended that they take it easy for the remainder of that day if at all possible.
Click here to find out more about an epidural steroid injection.