A treatment for acute and chronic spinal mediated pain.
There are four simple categories of treatment for pain:
1) Physical Therapy/Chiropractic/Modalities
2) Oral Medications
3) Injectable Medications
4) Surgery
While to goal for all spinal mediated pain is to normalize pain and function with treatments listed in categories 1) and 2), these measures can at times fail to provide meaningful clinical improvement. At that point, targeted injections of medications to the pain generator can be utilized to help with pain relief and to improve function.
What is an Epidural Steriod Injection?
An epidural steroid injection is a minimally invasive procedure used by intervention physiatrist to relieve both spine and extremity pain caused by disc herniation, disc degeneration, spinal stenosis, and inflamed nerve roots.
The medication is delivered to the inflamed spinal nerve through the epidural space. The epidural space is the area between the protective covering of the spinal cord (the dura) and the bony elements that form the spinal canal.
The injection includes a corticosteroid (betamethasone or dexamethasone) and a numbing agent (bupivacaine or lidocaine).
Corticosteroids reduce inflammation and have the potential to work very well when delivered directly to the site of pain. This can result in mild to significant improvement of pain. It is important to remember, however, that an epidural steroid injection is only a method of delivering medication. It will not change lumbar spinal anatomy or increase abdominal muscle strength. Therefore, we must have close working relationships with both our spine surgery and physical therapy colleagues should additional treatment be needed
Epidural steroid injections are often combined with physical therapy or home exercise programs to strengthen the back and core musculature, and to help prevent future pain.
How are Epidural Steroid Injections performed?
Epidurals steriod injections are performed using fluoroscopic guidance. The appropriate location to place the medication is first identified at your clinic appointment where you and your physical review physical exam and relevant imaging studies. Using a fluoroscope (a special type of X-ray), the physician directs a hollow needle through the skin and into the epidural space. There are two techniques used to access the epidural space, either an interlaminar or a transforaminal approach. The interlaminar approach advances a needle between the lamina of two vertebrae at the target location, through the ligamentum flavum, and into the posterior epidural space. The transforaminal approach aims to place the needle in opening of the neural foramen. This approach allows placement of medication into the anterior epidural space and closer to the spinal nerve roots. In both scenarios, contrast dye is used to confirm proper spread of medication. Most patients remain awake during the procedure and experience very little pain during the injection. Some patients elect mild or even heavy conscious sedation for comfort. Once the needle is in place and the steroid medication is delivered, the needle is removed and patients are moved to a recovery area and cleared to leave shortly thereafter. The entire procedure typically takes less than 10 minutes.
How Effective is an Epidural Steriod Injection?
Unfortunately there is not a “standard” amount of time a patient will feel relief following their epidural steroid injection. Pain relief may last for several weeks, or it may last for several years. This difference is determine by the underlining anatomy, individual physical condition, and genetics. Some pain is completely alleviated. Other pain results from complicated anatomy requiring surgery, and thus has very little response to the epidural injection.
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