Epidural Injections
Steroids are potent anti-inflammatory medications. The goal of an epidural steroid injection is to place this medication near the area of injury or pathology within the spine. The steroid medication reverses the effect of pain-producing inflammatory compounds produced by the body, thereby easing pain and allowing for improved function. A local anesthetic is usually injected with the steroid, which may provide immediate short-term pain relief. By combining a local anesthetic and steroid, diagnostic information may be obtained in addition to the provision of therapeutic relief. The most common use of epidural steroid injection is for spinal nerve irritation, commonly referred to as radiculopathy or, in the lower back, as sciatica. Epidural injections are also commonly used to treat intervertebral disc pain, spinal stenosis of various causes, intervertebral disc herniations/bulges, spinal arthritis, spinal fractures and post-herpetic neuralgia. The injections can be performed on any level of the spine.
Spinal Stenosis
Herniated Disc
Interlaminar Epidural Injections
In this technique, an x-ray (fluoroscopy) is used to guide a needle into the posterior epidural space. This procedure is beneficial for patients with diffuse disease processes involving several spinal levels or disease processes involving structures in the posterior spinal canal, the interlaminar technique is a reasonable approach.
Transforaminal Epidural Injections/Selective Nerve Root Block
This technique represents a very precise, x-ray controlled injection of a small volume of medication into the anterior epidural space and the exiting spinal nerve sheath. It is a useful technique for precisely diagnosing the specific level of the pain generation, as well as treating pain of disc or spinal nerve origin. When making a diagnosis, the suspected areas of pain generation are located on x-ray and a small needle is placed into the neural foramen (the spinal opening through which the spinal nerve exits). An X-ray machine (fluoroscope) is used to observe/confirm the appropriate spinal nerve level after a small amount of contrast is injected. The resulting contrast spread, called an epidurogram, can give valuable information regarding the anatomy at the injected level. Additionally, the patient may feel a paresthesia, or tingling sensation, in the area of the body supplied by the injected spinal nerve. Following this, a small amount of local anesthetic and steroid is injected to decrease inflammation and thereby providing analgesia and allowing for reduced pain and increased function. Several studies have confirmed that transforaminal epidural steroid injections are highly effective in treating radicular pain and can prevent surgery in two-thirds of patients.
Caudal Epidural Injections
This is a technique that accesses the epidural space near the tailbone. It is used for pathology/injury in the lower spine, such as pain in the coccyx or tailbone, or to access the epidural space in the patient with low back pain/radiculopathy and a history of previous lumbar surgery. By entering below the area of previous surgery, scars and surgically altered anatomy can be avoided. This is performed with X-ray guidance and contrast injection to assure correct needle placement.
