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Epidural Injections Epidural Steroid Injections (ESIs) are a common method of treating inflammation associated with low back related leg pain, or neck related arm pain. In both of these conditions, the spinal nerves become inflamed due to compression from the narrowing of the passages surrounding the nerves that exit the spine. Narrowing of the spinal passages may be due to variety of causes, including disc herniations, bone spurs, thickening of the spine ligaments, joint cysts, or even abnormal alignment of the vertebrae (slipped vertebrae).
The epidural space is a fat filled ‘sleeve’ that surrounds the spinal sac and provides cushioning for the nerves and spinal cord. Steroids placed into the epidural space have a very potent anti-inflammatory action that can decrease pain and allow patients to improve function. Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation and allow the body to compensate for the condition. In this way, the injections can provide benefits that outlast the effects of the steroid itself.
There are three common methods for delivering steroid into the epidural space: the interlaminar (medicine injected through the back part of spine), caudal (medicine injected at the base of the tailbone), and transforaminal (medicine injected near the disc and nerve root). All three methods entail placing a thin needle into position using fluoroscopic (x-ray) guidance. Prior to the injection of steroid, contrast dye is used to confirm that the medication is traveling into the desired area. Often, local anesthetic is added along with the steroid to provide temporary pain relief.
All three procedures are performed on an outpatient basis, and you can usually return to your pre-injection level of activities the following day. Some patients request mild sedation for the procedure, but many patients undergo the injection using only local anesthetic at the skin.