Epidural Steroid Injections
Epidural steroid injections are spinal injections meant to help relieve pain and improve function. These can be performed in the cervical spine, thoracic spine, lumbar spine, and the sacrum. In the cervical spine, epidural injection may relieve pain in the neck as well as the arms. Thoracic epidural injection can help with pain located in the upper to mid back as well as pain that radiates around the rib cage and into the chest or abdomen. Epidural injections in the lumbar spine target pain in the lower back as well as pain in the legs. Sacral epidurals may help with leg pain as well as some sacral pain disorders.
What is being injected?
Usually two medications, a steroid mixed with an anesthetic. More commonly these days the steroid used is called dexamethasone. The anesthetic is usually lidocaine or bupivacaine. The word epidural is not a medication name but rather the space in which the steroid and anesthetic medications are injected into.
The epidural space is the area located within the spinal canal between the vertebral wall and the dural sac (which covers the spinal cord and nerve roots) and contains fat and small blood vessels.
What it does
It helps alleviate pain and reduces inflammation usually caused by a disc injury or disc herniation which may result in nerve root irritation or compression. Other reasons may include spinal canal stenosis.
What it doesn’t do
Epidural injections do not repair disc injuries nor any other kind of injury. Nor do they promote healing of any tissue in the spine. In that sense epidural injections do not “fix the problem.” They also do not have any way of preventing pain from returning in the future. They are strictly meant for alleviating pain. Pain relief is usually short term (estimated average is 3 months).
Then why do it?
Usually recommended when pain is very severe, uncontrolled by medications, unable to tolerate exercise or physical therapy, and when surgery could be avoided or is not indicated. Epidural injections allow quick resolution of pain for a period of time during which the disc injury pain may resolve on its own and this is why the pain may not return. Not because the epidural “cured” the problem but because the injury process has run it course and pain did not come back. To prevent further reinjuries or return of pain the patient should develop a regular core strengthening exercise program and be educated on ways to avoid reinjury.
What are the risks?
Overall considered safe when performed with fluoroscopic (xray) guidance by a physician specialized in interventional pain management. Preferably one who is board certified and fellowship trained. Risks are similar to other spine interventions and include spinal headache, infection, bleeding, allergic reaction, pain aggravation, nerve injury, and paralysis (rare).
