Epidural Steroid Injections:
Epidural space is a space
overlying the membrane called dura mater, which
covers the brain and spinal cord. The
epidural space can be injected with various medications and the injections are
generally referred to as epidural injections.
An epidural steroid
injection is a spinal injection procedure that deposits potent
anti-inflammatory corticosteroid at the site of the painful reaction to disc
injuries, arthritic bone spurs, or spinal stenosis.
Approximately 50 - 80% of patients experience good to excellent results of
decreased pain and increased function. The closer to the time
of injury, the higher the success. The more the pain
in the lower extremity (sciatica) the better the outcome generally. For
a significant number of patients, the relief is long lived. Other patients may
require repeated injections. For those with temporary relief, the diagnostic
information is useful for planning other procedures or treatment.
These can be done straight through a midline
approach (Inter laminar epidural injections), through the opening in the bottom
of the tail bone (Caudal Epidural Injections), or through a side approach where
a needle is advanced to the spine from a corner into the opening in the side of
the spine (trans foraminal epidural injections/
selective nerve root blocks) where a specific nerve root comes out. These injections are done with the help of
x-ray machine and are called fluoroscopic-guided injections and the x-ray
machine is called a C-Arm. With the help
of these injections we can generally treat various conditions, which cause
significant lower back pain or sciatica.
Conditions commonly treated with epidural steroid injections include
herniated discs, degenerative or bulging discs, bone spurs or other condition,
which are bone spurs or other causes of pain such as cysts in the spinal canal,
which are causing lower back pain and sciatica.
These injections generally
tend to help patients who have more prominent sciatica than lower back pain
although both subgroups are helped significantly when appropriate injection or
injection combination is utilized. In
some cases, one may need to repeat the injection/injections for maximum
benefit. There is no limitation on how
many injections one can have through the life as if they spaced appropriately,
they can be done as needed. The key is
to do them on an as needed basis and not as standard where one has to get an
injection every so and so period of time.
The most significant
problems associated with the epidural injections can be nerve damage, spinal
cord damage, infection, allergic reaction, bleeding
and hematoma formation in the spinal canal or
headaches. Headaches are probably the
most common of the above side effects. Hematoma
formation can happen in one patient every 250,000 injections or so, which can
be significant and may need surgical decompression to stop the bleeding and
prevent paralysis.
Most patients tend to do
quite well with epidural injections. The epidural injections done with the help
of x-ray machine ( C arm) probably tend to be safer
than the ones done in pregnant women without the x-ray machine where the
patient is having contractions and lying in an uncomfortable bent
position. With the help of the x-ray
machine and proper anesthetic use, these injections can be done with minimum
pain and discomfort and can result in significant relief of pain.
For pictures of epidural injections, please see the link on spinal injections.