18 Apr How does an epidural steroid injection work?
Since 1952, physicians have used epidural steroid injections to relieve the symptoms of pain rooted in the spinal serves. This non-surgical intervention is chosen after previous interventions with more conservative management options have failed.
Epidural steroid injections are particularly effective in relieving the symptoms from conditions that cause inflammation and pain of the spinal nerves such as disc herniations, and serve a dual diagnostic and therapeutic purpose. While the goal of epidural steroid injections is primarily pain relief, they are also used as part of a comprehensive physical therapy and rehabilitation program.
The epidural space refers to the anatomic space on the outermost part of the spinal canal, outside the dura mater. The dura mater is the tough, fibrous material that serves as the covering of the spinal cord, the arachnoid matter, the subarachnoid space, the cerebrospinal fluid, etc. This extradural space contains many important structures such as the spinal nerve roots, fatty tissues, blood vessels, such as small arteries and the epidural venous plexus, and some lymphatics.
The technique involves direct injection of steroids into the epidural space. The most commonly used steroids are dexamethasone, methylprednisone, and other corticosteroids. These are powerful anti-inflammatory drugs that provide relief of symptoms by suppressing the inflammatory response, which relieves the irritation and swelling near the nerve root.
The steroids work by relieving the mechanical and chemical sources of pain. The injection of epidural steroids by a Chicago pain management doctor is usually accompanied by local anesthetics, which affords relief from pain that usually lasts anywhere from one week to a whole year. This makes it very useful in dealing with severe, acute attacks of pain. If this provides adequate pain relief, then you may receive up to three or four series in a one year period.
The procedure is done under a local anesthetic, although a mild sedative can be given to relax the patient. Prior to the procedure, the procedure site is scrubbed with a sterilizing solution such as povidone-iodine or chlorhexidine. Sterile linen is placed around the area.
The procedure begins upon the insertion of the needle into the injection site. This is usually done under fluoroscopic (X-ray) guidance, although other guidance techniques can also be used. The three most commonly used approaches are the caudal, transforaminal and laminar approach.
The caudal approach inserts the needle from the area near the sacrum (tailbone), and has
been reported to give up to 75% of patients relief of symptoms.
The transforaminal approach injects the steroid into the opening of the spine (foramen) of the spinal canal, and is preferred because of shorted operating time and lower radiation exposure.
The interlaminar approach is chosen when the other techniques cannot be used, and has been shown to provide comparable outcomes in relief of pain and other symptoms.
As with any invasive procedure, epidural steroid injections are not without risks. While the outcomes are generally positive, there is a risk of infection at the surgical site, intraoperative damage to the muscles, nerves and surrounding tissues, as well as the risk of bleeding and hematoma formation.
Premier Pain & Spine in Chicago has seven locations providing top notch medical and interventional pain management. The Chicago pain management doctors are Double Board Certified and experts in all three types of epidural steroid injections. Success rates are very impressive and most patients are able to avoid surgery as well.
Most insurance is accepted at the Chicago pain clinics, call Premier Pain & Spine today at (847) 519 4701 to schedule with a location close to you!
Botwin, KP et al. Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehab. Dec 2002, Vol 81(12), pp. 898-905.
Kim HJ, Rim BC, Lim JW, et al. Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc. Ann Rehabil Med. 2013 Dec;37(6):824-31. doi: 10.5535/arm.2013.37.6.824.