Epidural Steroid Injections

Pain Management for the Back and Neck

Mechanical causes of back pain in the low back and neck can be one of two types.

• Inflammation of the joints of the spine, strain and sprain of the muscles and ligaments of the spine or it may come from the disc space itself.
• Irritation or pressure on the nerve root that follows the course of a specific nerve down the leg or arm.

Epidural steroid injections allow a combination of steroid medication and a local anesthetic agent to be introduced around the spinal nerves. This is often beneficial in decreasing inflammation and improving pain.

Epidural Steroid Injection Treatments

To properly introduce epidural steroids into the location around the nerves, live x-ray (fluoroscopy) is used during the procedure. The patient is first sedated in the operating room by the anesthesiologist and, with the patient lying on the abdomen, the back of the lumbar region or cervical region is prepared with the sterilizing solution and sterile drapes.

After locally anesthetizing the skin, a needle is passed to the appropriate position around the spine. The needle can be introduced into the area of the neural foramen. This is known as a trans-foraminal epidural steroid injection. It may also be passed between the lamina forming the roof of the spinal canal, in which case it is called a trans-laminar epidural steroid injection. After the needle is placed in the appropriate position, proper location is confirmed by injecting dye under x-ray guidance. The steroid is then deposited around the nerve roots.

Risks

The risks of epidural steroid injections are low. Risks include bleeding and infection in and around the nerves and spinal cord, inflammation of the nerves, and elevation of blood sugars from the steroids.