Epidural Steroid Injections (ESI)
Home Procedures Offered Core/Standard Procedures Epidural Steroid Injections (ESI)
Epidural Steroid Injections (ESI)
ESI deliver anti-inflammatory medication into the spine to relieve cervical, thoracic, lumbar and caudal nerve root compression, reducing inflammation, pain and improving mobility in chronic back conditions.
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A nerve fiber that originates from the spinal cord through the openings within the vertebra is referred to as the nerve root. Occasionally, the nerve roots are compressed if the openings are either obstructed or narrowed by the adjacent structures. As a result, patients experience pain, tingling, numbness, and muscle weakness in the area supplied by this nerve fiber. This condition is characterized by inflammation, which is the main cause of the pain.
What are epidural steroid injections?
In the epidural space, corticosteroid injections are administered directly to a pinched nerve as it departs the spine within the epidural space. The epidural space is where the bones and discs of the spine surround the spinal cord and nerves. A vertebral disc can herniate into this space, resulting in inflammation and pressure around the spinal nerves.
The purpose of epidural steroid injections (ESI):
The cervical, thoracic, lumbar, and caudal vertebrae are all susceptible to nerve compression. Steroid injection in the spine, directly into the epidural space in these regions, is known as an epidural injection. An epidural steroid injection is the term used to describe the administration of steroids into the epidural space.
Back pain caused by a herniated disc, lumbar or cervical radiculopathy, spinal stenosis, or sciatica is frequently treated with epidural steroid injections. ESI for sciatica relief can significantly improve function and quality of life by reducing inflammation at the affected nerve. Corticosteroids are potent anti-inflammatory medications that can significantly reduce inflammation surrounding an irritated nerve when administered into the epidural space.
What are the ESI procedure steps?
1. Dr. Abraham ensures the best preparation for epidural injection by applying the fluoroscope to perform the procedure under X-ray guidance.
2. Dr. Abraham injects a combination of steroids and local anesthetic into the area where the nerve is compressed, as determined by fluoroscopy.
What to expect after ESI?
After cervical, thoracic, and lumbar ESI for nerve root compression, there is less pain and less inflammation in the affected area. The procedure may require up to an hour to complete. Then, the team of New England Advanced Spine and Pain Center for regenerative medicine observes the patients for a brief period before being discharged to their home.
How effective are epidural steroid injections and their mechanism of action?
Epidural steroid injections function by administering a potent anti-inflammatory to the spinal nerve compression site. The volume and concentration of injected medications can vary on an individual basis, and they may include steroids, local anesthetics, and saline. Although epidural injections for other applications may not necessitate image guidance, epidural steroid injections for pain management are frequently administered with fluoroscopic or X-ray guidance to guarantee the safe, effective, and accurate placement of the injected medications.
• Cervical and thoracic epidural steroid injections:
Epidural steroid injections can be administered to the cervical and thoracic spine to address radiculopathy, degenerative disc disease, spinal stenosis, and cervical or thoracic herniated discs. These conditions result in neuropathies and symptoms that radiate to the arm and hand in the cervical region (neck). Pain from the thoracic region may extend to the ribcage or flank. ESI for neck pain can be performed using an interlaminar or transforaminal approach.
• Lumber and caudal epidural steroid injection:
o Multiple methods may be used to perform steroid injection for back pain in the lumbosacral spine, which includes the vertebrae of the lumbar spine and the sacrum of the lower back. Based on your diagnosis and any prior spine surgeries, Dr. Abraham will determine the appropriate method for you.
o An interlaminar or translaminar epidural steroid injection is capable of directly delivering the medication into the epidural space at the affected level and treating multiple levels or both sides simultaneously.
o The medication is administered through a transforaminal epidural steroid injection to the region where the specific affected nerve root departs the spine and is compressed by a disc herniation. In the lumbar spine, it is the standard first-choice approach for an epidural injection.
Safety of epidural steroid injections:
Bleeding, infection, and nerve injury are all potential risks of epidural injections associated with any procedure that involves a needle. These risks are exceedingly low when implemented correctly with the best anesthesiologist and pain management specialist, Dr. Abraham, and are typically outweighed by the epidural steroid injection benefits.
Dr. Abraham assesses the risks and benefits of repeated epidural steroid injections on a case-by-case basis for patients who have or are at risk for osteoporosis, as some evidence indicates that repeated steroid injections can accelerate bone loss, so he may recommend alternatives to epidural steroid injections.
Epidural injections frequency and cost:
• Epidural injection for herniated disc is administered three to six times annually.
• In the event of a new disc herniation, injections may be administered at intervals of only a few weeks to achieve a rapid and complete resolution of symptoms.
• It is common for chronic conditions to require injections every three to six months or longer.
• It is common for chronic conditions to require injections every three to six months or longer.
• The cost of epidural steroid injection can vary depending on location and insurance coverage, but it remains one of the most accessible and effective options for managing back pain. ESI vs surgery for back pain is a cost-effective, nonsurgical solution.
How long does ESI last?
In patients with a new disc herniation who respond favorably, epidural steroid injections can assist in the lasting relief of pain. For patients with chronic pain or recurrent disc herniations, the effect lasts for three to six months or longer.
The epidural injection success rate depends on the underlying cause of pain, but studies show that many patients experience significant and lasting improvement.
What are the potential side effects of epidural steroid injection?
Mild injection site pain, temporary exacerbation of pain, flushing, insomnia, or elevated blood glucose levels are among the most prevalent adverse effects. These are typically self-limiting, and the epidural injection recovery time is within one to three days.
If you’re struggling with persistent back or leg pain and want to avoid surgery, consult Dr. Abraham, board-certified anesthesiologist and pain management specialist at the New England Advanced Spine and Pain Center, to discuss whether an epidural steroid injection is right for you.