Epidural Steroid Injection

Being both diagnostic and therapeutic, epidural steroid injections are one of the most common treatments in pain management for a variety of back and leg pain issues

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Is an Epidural Steroid Injection Right For You?

What is an Epidural Steroid Injection?

A lumbar epidural steroid injection (lumbar ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around the spinal nerves in your low back.

The main goal of lumbar epidural steroid injections is to manage chronic pain caused by irritation and inflammation of the spinal nerve roots in your low back (the lumbar region of your spine) due to certain conditions or injuries. This type of chronic pain is called lumbar radiculopathy (radicular pain), which can radiate down from your low back to your hips, legs and/or feet.

You will likely have your lumbar epidural steroid injection in a hospital or an outpatient clinic. In most cases, a lumbar ESI takes 15 to 30 minutes. It’s important to be very still during this procedure.

There are different ways your healthcare provider can access the epidural space around your spinal cord in your low back, which include:

          • Interlaminar ESI (IESI): With this method, the path of the needle is in between two laminae in your spine to get to the epidural space. A lamina is the flat plate of bone that’s part of each vertebra in your spine that protect your spinal cord.
          • Transforaminal ESI (TFESI): With this method, the path of the needle is through the foramina, which are openings through which nerve roots exit your spine.
          • Caudal ESI: With this method, the path of the needle is through the sacral hiatus, which is towards the bottom of your sacrum and just above your tailbone, to reach the lowest spinal nerves. 
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Who Is This Procedure For?

See if an Epidural Steroid Injection is Right for Your Pain
Diagnosis
      • Healthcare providers use lumbar epidural steroid injections to manage a type of chronic pain known as lumbar radicular pain, which is caused by spinal nerve root inflammation and irritation in your low back.
      • An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.
Causes
      • Many conditions can irritate your spinal nerve roots in your low back and cause lumbar radiculopathy (sciatica), including:
        • Lumbar herniated disk: This condition is also commonly called a slipped, ruptured or bulging disk. Disks have soft, gel-like centers and a firmer outer layer. Over time or with an injury, the outer layer weakens and can crack. A lumbar herniated disk happens when the inner substance pushes through a crack in one of the disks between two vertebrae in your low back. The leaked material may press on, irritate and/or pinch nearby spinal nerves.
        • Lumbar degenerative disk disease: This condition happens when the cushioning in between the vertebrae in your low back begins to wear away. A degenerated disk could cause local inflammation in your spinal nerve roots.
        • Lumbar spinal stenosis: This condition is the narrowing of one or more spaces within your lumbar spine. Less space within your spine reduces the amount of space available for your spinal nerve roots. A tightened space can cause the nerves to become irritated or pinched, which can lead to low back pain, especially with repeated activity like walking.
        • Lumbar osteoarthritis (lumbar spondylosis): This condition involves changes to the bones, disks and joints in your low back caused by the normal wear-and-tear of aging. Lumbar osteoarthritis can lead to narrowing of the interior of your spinal column in your low back or in the openings where spinal nerves exit, which can cause inflammation and irritation to the nerves.
        • Other conditions that may be treated with lumbar ESIs include:
          • Localized low back pain (axial back pain): Axial low back pain can vary widely and have numerous causes. It can be a sharp or dull pain that you experience constantly or infrequently, and the pain can range from mild to severe.
          • Neurogenic claudication: This condition happens from compression of the spinal nerves in your lumbar spine. It can cause pain or tingling in your low back and one or both of your legs, hips and buttocks. These symptoms are especially present when you’re standing upright or walking.
Symptoms
      • Lumbar radicular pain is often called sciatica. Lumbar radicular pain can cause the following symptoms, which can radiate from your low back down the back of your leg below your knee to your calf and/or foot:
        • Pain.
        • Numbness.
        • Muscle weakness.
        • Tingling
What are the Results?
      • Many patients experience some pain relief benefits from ESI. For those who experience only mild pain relief, one to two more injections may be performed, usually in 1-4 week intervals, to achieve full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with a physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.
      • Many people experience temporary pain relief from lumbar epidural steroid injections, and some people even experience longer-term relief lasting up to 12 months. However, some people do not experience any pain relief from ESIs.
      • The goal of lumbar epidural steroid injection is typically to provide adequate short-term pain relief so that you can begin or continue physical therapy or to try to avoid more intensive pain relief procedures. Physical therapy may help promote long-term pain relief by strengthening the muscles that support your spine.
      • If a lumbar ESI works for you and results in pain relief, your healthcare provider may recommend another injection later on. However, most providers limit people to two to three ESIs per year.

Is an Epidural Steroid Injection Right For You?

If you suffer from low back or leg pain, an epidural steroid injection may be the best first step for you
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