Epidural steroid injections (ESI) are one of the many treatment options offered by Long Island Rehabilitation Medicine. At our offices in Nassau, Suffolk, and Queens Counties, you will find that our focus is on pain management and improved function, not surgery. Our highly-skilled, physiatrists have excellent credentials and a widespread reputation for customized care. We have a great deal of experience helping patients who before visiting our offices considered their back pain intractable.
Important Definitions
To understand epidural steroid injections, it is helpful to know the following definitions:
- Vertebrae — bones of the spine
- Discs — cushions between the vertebrae
- Dura mater — the membrane (sac) covering the spinal cord and nerve roots
- Epidural space — the fat-filled space surrounding the dura mater
- Steroid — corticosteroids are drugs that reduce inflammationÂ
- Fluoroscopy –an imaging technique that uses X-rays to show moving images of the interior of the body in real time
It is also helpful to know that nerves travel through the epidural space of the spine to the back and legs which is why many patients with back problems also suffer pain radiating down their legs.
What are epidural steroid injections and how do they help back pain?
Epidural steroid injections are administered under fluoroscopic guidance so the doctor can see the internal site clearly on a screen while performing the procedure. Because of continuous X-ray images provided by fluoroscopy, the doctor can target the precise location to inject with the medication necessary to reduce inflammation which in turn alleviates pain.
Epidural steroid injections can be administered in one of two ways:
- Transforaminal injections enable placement of the steroid at the site of the inflamed disc or nerve root
- Interlaminar injections allow the medication to spread through a targeted area in the epidural space.
During the injection procedure, two other medications are used in addition to the steroid: a contrast dye to make the flow of medication highly visible and a local anesthetic to keep the patient comfortable. Depending on which part of the spine is injected, epidural steroid injections may relieve pain in the neck (cervical pain), lower back (lumbar pain), arm or leg (radicular pain).
Benefits of Epidural Steroid Injections
The positive effects of ESI can be remarkable. Though not universally successful, for a great many patients they provide pain relief and increased mobility, sometimes for many weeks, months, or even years. They may enable patients to engage in physical therapy and increased exercise that can bring further relief. While some patients experience major relief after just one injection, others may benefit from several — administered at prescribed intervals.
Conditions Frequently Treated with Epidural Steroid Injections
Patients who have been diagnosed with any of the following conditions may be good candidates for this course of treatment:
- Spinal stenosis — narrowing of the spinal canal that results in pressure on nerve roots resulting in back and leg pain, especially when walking or standing
- Spondylolisthesis — weakness of the lower vertebrae that causes one vertebra to slip forward, compressing nerve roots, resulting in pain
- Herniated disc — bulge or rupture of the gel-like material within the disc that presses on a spinal nerve
- Degenerative disc — breakdown of disc tissue, usually as a result of wear and tear due to aging
- Sciatica — pain that radiates along the sciatic nerve in the buttocks and down the legs
- Bone spurs — bony projections that may develop on the spine due to osteoarthritis and narrow the spinal canal
The Procedure Itself
ESI takes between 15 and 45 minutes and is followed by a short recovery period. Though you will be awake during the procedure, you will have a sedative beforehand so that you feel relaxed. Before injecting you, we will administer a local anesthetic so that you feel as comfortable as possible. In most cases, patients feel pressure rather than pain when receiving the injection.
While inserting the needle through the skin into the epidural space between the vertebrae, we will be watching fluoroscopic images carefully to ensure that we are at the targeted location. Once the needle is properly placed, we will inject the anesthetic and corticosteroid into the epidural space around the nerve roots. Depending on the location being targeted, we may repeat the injection on the other side if necessary.
What happens after an ESI treatment?
After a brief recovery period, during which you may walk around, you will be able to go home. Because some people experience slight weakness or numbness, you will need someone to drive you. Most patients resume their regular schedule the next day. If you feel sore around the injection site, we recommend using ice packs and taking acetaminophen (Tylenol).
Now is the time to pay attention to any alterations in your pain level to determine whether the ESI has been helpful and to what extent. Patients sometimes feel a slight increase in pain as the local anesthetic wears off, but most are then delighted to feel considerable relief as the corticosteroid kicks in within a day or two. If you experience only mild pain relief from ESI, we may recommend one or two more injections at intervals ranging from 1 to 4 weeks.
Not Everyone Is a Good Candidate for ESI
At Long Island Spine we always take a full medical history and do a physical examination before determining which treatment options are best in your particular case. You are not a good candidate for ESI if you have bleeding problems or are pregnant (fluoroscopy could harm your unborn baby).
You also may not be able to have the injection if you have seriously elevated blood pressure, type 1 diabetes, take blood-thinning medication, or have glaucoma. You should be aware that there are the same low-level risks involved with ESI as with other minimally invasive injection procedures. We always go over potential risks with you before you undergo any procedure while in our care. Our physicians, in such instances, work in consultation with your primary care physician or medical specialists to clarify your candidacy, plan appropriately, and maximize safety.
Contact Long Island Spine To Discuss ESI and Other Effective Pain Relief Options
Though results are not guaranteed, a large number of our patients have experienced welcome relief due to epidural steroid injections. For some, the impact has been dramatic, even life-changing, enabling them to feel more comfortable and mobile than they have in years. Why not get in touch with our talented professionals now to see if epidural steroid injections are right for you?