Epidural Steroid Injection (ESI)
Epidural Steroid Injection
Cervical epidural steroid injections are a frequently used treatment for neck and head chronic pain syndromes. Chronic neck pain and cervical radiculitis are the most commonly treated condition with cervical epidural steroid injections. Headaches and cervical spinal stenosis may also benefit from this treatment modality.
What is Cervical Radiculitis?
Cervical radiculitis results from nerve compression in the neck (cervical spine) that causes radiating pain down an arm. The pain originates from cervical spinal nerves becoming irritated as they exit the spinal cord. The symptoms of cervical radiculitis often include numbness and pain. If a person develops weakness in this distribution it is termed radiculopathy. Cervical radiculitis can be caused by bulging cervical discs or cervical spondylosis, which results from arthritis in the facet joints. Both causes can often be effectively treated with cervical epidural steroid injections.
The most important and greatest success achieved with the use of cervical steroid injections is the rapid relief of symptoms that allows you to become active again. With this pain relief, you often regain the ability to resume normal daily activities.
Lumbar Epidural Steroid Injection
Lumbar epidural steroid injections are a common procedure performed to alleviate low back pain and shooting leg pain. It involves a needle injection into the middle of the low back. This procedure is performed on an outpatient basis in a series of three injections spaced one week to one month apart for maximum effect.
How Do Lumbar Steroid Injections Work?
The spinal cord, which contains the nerves that control the body, is protected by 3 layers:
Within these layers is the cerebral spinal fluid that provides nutrition to the spinal cord. Surrounding all of this is the bony cage of the spinal column. The epidural space is located between the bony cage and the dura mater.
To reach the epidural space, the needle is placed in the middle of the back and must pass through the skin, muscles, between the bones of the spinal column, and ligaments. Before the injection is performed, the skin of the back will be cleaned with an antiseptic to help prevent infections. The back will be anesthetized with a local anesthetic, but the anesthetic itself may cause stinging and burning.
Sometimes it may be difficult to perform the injection because the epidural space is very small and narrow. Since the tip of the needle cannot be seen, the injection is performed by “feel” and the landmarks of the back. It is important to slouch the back towards the physician and to hold still for ease of injection.
The effects of the injection should be felt in about 3-5 days and last about 1-3 months.
Who Can Benefit from Lumbar Pain Injections?
Nerve irritation of the spinal cord is felt to be a reason for low back pain and shooting leg pain. This can be caused by:
Spinal stenosis squeezing the spinal cord
Disc herniation hitting the spinal nerves
Spinal column arthritis
The steroids should calm the spinal nerves with its anti-inflammatory effects resulting in less back pain and shooting leg pain.
The complications of lumbar epidural steroid injection are related to the injection and to steroid effects. Bleeding, pain, headache, and infection can result from the injection. Weight gain, water retention, suppression of the immune system, and suppression of the body’s own natural steroids can result from steroid use. These considerations should be taken into account before any steroid injections.