Epidural Steroid Injections: Spinal Pain Solutions

An Epidural Steroid Injections (ESI) is a common modality used in pain management in order to diagnose and treat causes of chronic or acute pain which is thought to be originating from the spinal column.  ESI is considered a safe and beneficial treatment for pain that has been in use since the 1950’s.  

Disc protrusions, spinal arthritis, and overgrowth of tissues (ie. bone and ligaments) can lead to narrowing of the spinal canal (spinal stenosis) or the areas where nerves exit the spine (for instance lateral recess or neural foraminal narrowing).  The causes of these changes can be from overuse or the aging process (ie. wear-and-tear), or be the result of an injury or surgery.  When the spinal canal becomes compromised, the spine or the spinal nerves can become inflamed which may cause pain in the distribution of the nerve(s) or part of the spine.  A steroid (an anti-inflammatory medication) is injected with the intention of decreasing the pain-causing inflammation.  The steroid (often mixed with a numbing medication or local anesthetic) can be placed into specific regions to diagnose the cause or location of pain.  This can help guide future treatments including proper exercise, future interventional injections or surgery.

There are many different types of corticosteroids (often known as a “Cortisone”) used in the epidural space, and may be mixed with sterile saline or local anesthetics for different effects.  There are also many different techniques and ways of getting the medication to the indented target in the neck, mid-back or low back.  Transforaminal injections target specific levels and side where the nerve(s) exits the spine, whereas interlaminar or translaminar injections are targeted directly at the spinal canal (think needle placement for a labor epidural).  The very first epidural injections were placed in the space just above the tailbone, known as a Caudal ESI, and are still in use today.  Procedural imaging, such as X-ray (fluoroscopy), and contrast injection are typically used to help guide the injection, and have been shown to improve accuracy and outcome.

Figuring out if and which type of ESI would be appropriate for a specific patient and painful condition requires a thorough examination and review of history by a licensed pain management specialist.  In addition to history and physical exam findings, imaging modalities such as MRI are often employed to help localize the cause of the pain.

As with any type of intervention, there are some risks.  Complications such as bleeding and infection are luckily extremely rare, and are most often the result improper technique or contaminated steroid (such was the case in the series of meningitis in 2013- that medication is no longer available, and the compounding pharmacy that improperly prepared this medication has since been shut down). 

If you suspect or have been told that your pain may be originating from your spine, you should talk to your licensed pain management provider about diagnostic and treatment options, including Epidural Steroid Injections.

 

-Russell Kinder, MD

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