Epidural Steroid Injections

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Epidural Injections, also known as epidural steroid injections or ESI injections, are often utilized in the management of low back pain, neck pain, or leg or arm pain.  They may be used before or after other treatments have been tried.  When conservative treatments (over-the-counter anti-inflammatory drugs, physical therapy, rest) have failed to adequately mediate a patient’s back pain, physicians may then turn to other means. Epidural injections are one such measure, depending on the location, severity, duration, and root cause of a patient’s back pain. In order to perform an epidural injection, however, the presiding physician (typically a pain specialist, neurosurgeon, orthopedic spine surgeon,  interventional radiologist, anesthesiologist, or physiatrist) will need to narrow the possible causes of a patient’s back pain through extensive imaging tests (x-rays, magnetic resonance imaging, etc.). Epidural steroid injections can be used in the lumbar spine and epidural injections can also be used in the cervical spine.

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During the epidural injection procedure itself, the patient is face-down on a special table. Occasionally a mild sedative may be necessary, but most back pain patients do not require it. The physician then cleans and numbs the injection sites around the spine (these normally correspond to the most damaged parts of the spinal column, though not always), utilizing sterile technique.  After the injection sites have been prepared, the physician utilizes a fluoroscope, which is a type of x-ray procedure that produces live video, allowing the physician to respond in real-time to the structures inside the spinal column. This reduces the incidence of physician error as well as provides the physician with visual information regarding the most effective injection sites to help preserve a patient’s long-term mobility in addition to lowering back pain levels.

Epidural injections / epidural steroid injections / ESI may be given traditionally through two different routes in the lumbar spine (understanding the spine and lumbar anatomy is important). One route of the epidural steroid injection is known as a translaminar ESI.  During the translaminar epidural steroid injection, the needle is placed between the lamina (covering of the spinal canal) into the epidural space.  This is typically done using what is know as a “ loss of resistance technique.” During this technique, the physician pushes air or liquid (using a low resistance syringe known as a pulsator syrings) as he / she advances the needle, under fluoroscopic guidance, between the spinal lamina, and into the epidural space.  Once this space is reached, the physician will aspirate (pull back on the syringe) to make sure that no cerebrospinal (CSF) fluid is withdrawn, which would indicate a cerebrospinal fluid leak.  Assuming this is negative, the physician then injects contrast dye around the thecal sac, and it this shows a good image, he / she places the anesthetic and steroid agent around the spinal dural canal, and removes the needle.

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Another type of epidural injection / epidural steroid injection / ESI may be given through what is known as the transforaminal approach.  During this approach, the physician advances a needle, under fluoroscopic guidance, past the neural foramen through which the nerve leaves the spinal canal, and into the space known as Kambin’s triangle.  In Kambin’s triangle, the exiting nerve of the lumbar spine can be found.  Again, after aspirating the needle, and finding no return of cerebrospinal fluid (CSF), dye is instilled around the nerve to confirm proper epidural flow, and then the anesthetic agent and steroid are instilled around the nerve root.

Sometimes epidural injections are necessary given the physical changes in the spinal column as we grow older. Our spinal discs (the shock-absorbing pads between our vertebrae) gradually become thinner, harder, and less capable of bearing the stresses of everyday motion. This shrinks the distance between the vertebrae in our spinal column, increasing the chances for compressed spinal nerves. Since our spinal nerves are located very near the discs and vertebrae, patients with advanced degeneration in their spinal discs often have a smaller range of motion in order to avoid repeated nerve compression, which causes extreme back pain.

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Sometimes epidural injections may be supplemented with nerve block injections in order to give the physician more information about what may be causing the patient’s back pain. During a nerve block injection, specific nerves are targeted with anesthetics and steroids. If the patient experiences complete relief from their back pain, the doctor knows that the correct group of spinal nerves has been targeted. From there, physicians can make inferences about the best site for long-term anti-inflammatory drug injections. If none of these procedures provide the patient with meaningful relief from their back pain, physicians may then consider back surgery as a corrective measure.

Physicians at the Kraus Back and Neck Institute (KBNI) (located in Houston TX)  have significant expertise at performing spinal epidural steroid injections.  They incorporate a philosophy of practice which tries to treat a patient with conservative approaches whenever possible, frequently helping patients to avoid the need of surgery.  When a surgery is needed to help pain, neurosurgeon experts at the KBNI have the latest skills in minimally invasive microneurosurgery of the spine.

The Kraus Back and Neck Institute (KBNI) in Houston TX takes care of patients in Houston and the surrounding areas, including Sugarland, Woodlands, Katy, Spring, Sealy, Baytown, Pearland, Beaumont, Galleria, Tomball, Conroe, Humble, Kingwood, Port Arthur, Galveston, Memorial City, Texas Medical Center  (TMC) and other Texas TX cities including Dallas, Fort Worth, San Antonio and Austin.