Epidural Steroid Injection (ESI)
Epidural steroid injections (ESI) are commonly used to relieve pain in the neck, arms, back and legs caused by inflamed spinal nerves and bulging discs. The injections deliver the anti inflammatory medication called “steroids” into the epidural space. This allows the medication to target the spinal nerves, discs and spine joints. By reducing inflammation, pain is relieved for years, allowing individuals to regain normal activities and allow for healing. Conditions that commonly benefit from ESI include spinal stenosis, degenerative disc disease, disc herniation and spondylolysis.
Who are Good Candidates for ESI (Epidural Steroid Injections)?
Patients with pain the back, neck, arms or legs can benefit from epidural steroid injections. Specifically, the following diagnosis have been proven to respond well to Epidural Steroid Injections
- Disc Herniation – In between the vertebrae in our spine, there are gel-like discs that absorb the shock and pressures our spine encounters on a daily basis. If you receive too much impact, like in a fall, car accident, lifting heavy or other major injury, it may cause the disc to slip out, or herniate, out of place. When it protrudes out, it can hit the nerves that run alongside the spine, which can cause pain in the back, neck or extremities.
- Degenerative Disc Disease (DDD) – DDD is a common condition that comes with age. Again , Degenerative Disc Disease is a natural process of aging. With this process, the disc loses its elasticity and hydration which can cause the disc space to narrow and the disc to tear. This can also be a significant factor in back and neck pain.
- Spinal Stenosis – Arthritis and other conditions that cause abnormal bony formations and ligament thickening can cause narrowing of the spinal canal where spinal nerves run up and down the spine. This is called spinal stenosis or spinal narrowin. The narrowing within the vertebrae irritates the spinal nerves, causing significant neck, back and/or leg pain. Some people are predisposed to having spinal stenosis. Stenosis is another word for Narrowing.
- Spondylolysis – When one of the spinal vertebrae slips forward from an injury or fracture, it can compress nerve roots and cause pain. Dr Morchower uses xray and MRI imaging to detmine the extent of the vertebral slipping and develop a treatment plan based on the patient history, imaging and physical exam.
- Sciatica – The low back (lumbar and sacral) nerves that exit the spine come together to form a the largest nerve in the body. This nerve serves the legs and is called The Sciatic Nerve. When muscles that surround the low back are tight or injured or when you develop a slipped or bulging disc, it can compress the nerve and cause pain in the back and down the entire leg. Similar problem can develop in the neck and shoot pain down one or both arms.
Epidural steroid injections are also helpful in determining whether or not an individual will be a good candidate for surgical intervention. This is one reason we advise that patients consult with Dr. Morchower prior to making a decision to proceed with neck or low back surgery.
ESI can also aid in helping individuals through intensive rehabilitation exercises that would otherwise be impossible if pain was not controlled.
How is it Performed?
- Dr Morchower is specially trained to perform epidural steroid injections. As an outpatient procedure, Epidural Steroid Injections are minimally invasive and typically take between 6-15 minutes to complete.
- With the patient lying face down on an x-ray table, local anesthetic is injected to numb the area to be treated. “Twilight Sedation” may be used to put a patient to sleep during the procedure, however the patient will continue to breath on their own. Patients are able to wake up minutes after the procedure is over. For example, this is similar to the sedation you would receive during a colonoscopy.
- Under the aid of an X-ray machine (Fluoroscopy), Dr. Morchower guides a needle into the epidural space between the bony vertebrae. The fluoroscope allows the physician to watch the needle in real-time as the steroid medication is delivered close to the inflamed nerve roots without touching the nerve. If anything, the patient may feel some pressure during the delivery of the steroid. Dr Morchower is trained in multiple approaches and typically utilizes a lateral or transforaminal approach in order to deliver the anti-inflammatory medication more directly on the nerves and discs. This has proven to be more effective for his patients.
- Post-treatment – Once the sedation medication has worn off, individuals can walk around, but driving is not allowed for several hours following the procedure. Daily activities are often resumed the next day. Mild soreness or swelling may be present at the injection site. Ice and/or advil may be used for relief.
Pain relief is usually achieved 2-4 days following the procedure, however this can vary and often relief occurs the day following the epidural steroid injection. In order to gain the most and longest pain relief from the ESI, It is not uncommon to need more than one treatment, typically separated by one or several weeks. Epidural steroid injections work best in conjunction with physical therapy and home exercises that aim to strengthen the muscles of the back in order to prevent further injury and continued or recurrent pain.
The results of ESI’s can last several years and prevent patient from having to undergo spinal surgery in most cases.
*Individual Result May Vary*