Epidural Steroid Injections
Spinal injections are not new. The use of spinal injections to treat low back pain was first documented in 1901, and in 1952 epidural steroid injections were first used to treat low back pain with associated sciatica (pain in the sciatic nerve due to lumbar disc herniation). Today, epidural steroid injections have become an integral part of non-surgical management of low back pain.
Several common conditions, including a lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis, can cause severe acute or chronic low back pain and/or leg pain. For these and other conditions that can cause chronic pain, an epidural steroid injection may be an effective non-surgical treatment option. While the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for patients during an episode of severe back pain. Importantly, it can provide sufficient pain relief to allow the patient to progress with their rehabilitation program.
An epidural is an injection that delivers steroids directly into the epidural space within the spine. Sometimes a flushing solution (either lidocaine or normal saline) is also used to help “flush out” inflammatory proteins from around the area that may be the source of pain. The epidural space is the area between the dura mater (a membrane) and the vertebral wall and is filled with fat and small blood vessels. It is located just outside the dural sac. The dural sac surrounds the nerve roots and cerebrospinal fluid (the fluid that the nerve roots are bathed in).
An epidural steroid injection usually takes between 15 and 30 minutes. The patient lies flat on an x-ray table on their abdomen. Prior to the epidural injection, the skin is numbed with lidocaine, which is similar to the novocaine that the dentist uses (a “local” anesthetic).Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space, as controlled studies have found that medication is misplaced in 13% to 34% of epidural steroid injections that are done without fluoroscopy.
Once the needle is in the exact position, the epidural steroid solution is injected. Following the injection, the patient is usually monitored for 15 to 20 minutes before being discharged to go home.
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