An epidural steroid injection is typically defined as a minimally invasive procedure that provides relief from chronic back, leg, neck, and arm pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation.
The primary objective is to reduce pain so that you may resume normal activities and a physical therapy program.
These Epidural injections specifically involve injecting an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone), close to the affected nerve. The needle is then carefully placed into the “epidural space,” located outside the membrane that protects the spinal cord. The medication then helps to reduce the inflammation and lessens or resolves the pain.
How Injections provide relief from the pain
Injections deliver medication directly to the anatomic location that generates pain, which may provide more neck and back pain relief than oral medication. Injections for back and neck pain may work in either of the ways:
- Directly deliver steroids or any other pain-relieving medication to the area that is the source of the pain to reduce inflammation and numb the pain.
- Create a heat lesion on a pain-transmitting nerve to prevent it from sending pain signals to the brain.
Benefits of Spinal Injections:
- Decreases swelling and inflammation
- Reduces nerve irritation
- Rapid pain relief
- May prevent operative treatment
- Improvement in function and quality of life.
Spinal injections are always performed under x-ray guidance, called fluoroscopy. This provides accurate placement of the medication and confirms the safety of the procedure. To do this procedure, a liquid contrast (dye) is then injected just before the medication. If this liquid contrast does not flow in the correct location, the needle is repositioned, and additional dye is injected to obtain the proper flow.
Types of spinal injection
Epidural injections are primarily used to treat pain that commences from the spine and radiates to an arm or leg.
This arm or leg pain often occurs when a nerve is inflamed or compressed.
These Epidural injections involve injecting an anesthetic or an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. The needle is carefully placed into the "epidural space," which is located just outside the membrane that protects the spinal cord. The medication significantly reduces the inflammation and reduces the pain. This type of epidural injection is typically a therapeutic one.
For strictly diagnostic purposes, a spinal epidural injection can be injected at the isolated nerve to determine if that particular nerve is the source of pain.
Sometimes, however, only an anesthetic injection is injected. The immediate response to the injection is then closely monitored. If the pain is completely relieved, then that specific nerve is the primary cause of the pain symptoms. However, If there is little pain relief, then there is another source of pain.
Facet Joint injections
These types of injections can also be done for both diagnostic and therapeutic reasons.
Facet joint injection in the lumbar spine:
Facet joint injections are placed into and around the facet joints, which are like the small joints typically located between each vertebra on the back of the spine.
Facet joint injections are often used when the pain is caused by degenerative/arthritic conditions or any injury. They are used to treat pain in the neck and back. The pain does not have to be limited to the midline spine, as these problems can sometimes cause the pain to radiate into the shoulders, buttocks, or upper legs.
Facet joint injection in the cervical spine:
For treatment, facet joint injection can be injected in two ways: Injecting the anesthetic directly into the joint or anesthetizing the nerves carrying the pain signals away from the joint.
If the majority of pain is relieved with the anesthetic into the joint, then a therapeutic injection of a steroid may provide lasting pain relief.
If the anesthetic injections indicate that the nerve is the source of pain, then permanently block the pain signals. It is done with the help of radiofrequency ablation or damaging the nerves that supply the joint with a "burning" sensation.
Sacroiliac Joint Injections
Sacroiliac joint (SI joint) injections are quite similar to facet joint injections in a lot of ways.
The SI joints are situated in between the Sacrum and Ilium (pelvic) bones.
Some problems in the SI joints have been the reason behind the pain in the lower back, buttock, and leg.
Typically, one joint is painful and causes pain on one side of the lower body. It is less common for both SI joints to be painful at the same time.
This joint can also be injected for both diagnostic as well as therapeutic purposes.
Anesthetizing the SI joint with the help of injection under x-ray guidance is considered the best for diagnosing SI joint pain.
An injection of the sacroiliac joint with anesthetic should remarkably decrease the amount of pain in the low back, buttock, or upper leg.
A therapeutic injection typically includes a steroid medication to provide more extended pain relief.
Frequently Asked Questions
What are the side-effects?
More common side effects of spinal injections include headache, bleeding, and flushing. Patients with diabetes may experience a temporary increase in their blood sugar. This should be discussed with the physician before the procedure. Patients may also experience a temporary sensation of numbness and tingling.
Is any type of anesthesia used for the procedure?
Typically a local anesthesia is injected into the skin, numbing the area where the epidural needle is placed. Patients may experience mild discomfort but not severe pain.
Who generally performs epidural steroid injections?
Epidural steroid injection is performed by physiatrists, pain management physicians, and radiologists, all of whom have the expertise necessary to perform this procedure safely.
Is any specific preparation required before the procedure? Can I eat before and after the procedure?
Your physician will give instructions before the procedure. Generally, patients come in about one hour before the process. Some patients also require blood work to rule out an infection or bleeding risks. Patients usually are advised to eat a light meal 4 hours before the procedure, and they can resume their healthy eating habits after the procedure.