Epidural Steroid Injections

Epidural Steroid Injections

The traditional epidural (ep-e-do-ral) steroid injection technique involves the physician feeling the patient’s spine in order to guide the placement of the needle between the spinal vertebrae. A newer technique involves using x-ray fluoroscopy to guide the needle directly into the neural foramen; the point where the affected nerve root exits the spinal canal. Injections of steroids into the lumbar epidural space are particularly useful to alleviate pain that radiates from the lower back into a leg. This pain may be caused by disc herniation or spinal stenosis, which triggers nerve root irritation, inflammation, and pain. Similarly, ESIs are used to treat neck pain that extends into the arms.

Overview – Epidural Steroid Injection
This injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

Patient Positioning
The patient lies face down. A cushion under the stomach area provides comfort and flexes the back. In this position, the spine opens and allows for easier access to the epidural space.

Tissue Anesthetized
A local anesthetic is used to numb the skin. All the tissue down to the surface of the lamina portion of the lumbar vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized track.

Fluoroscopic Guidance
Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip.

Steroids Injected
A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.

End of Procedure
The needle is removed, and a small bandage is applied to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. Many patients get significant relief from only one or two injections.