Epidural Steroid Injections
are done only for :
Leg pain/ numbness/ tingling
or nerve exam findings are bad
and in association with rehabilitation (exercise + therapy)
Epidural space is the space outside the spinal cord and just inside the vertebrae, where the needle is put into.
First a diagnostic block may be performed (Selective Nerve Root Block):
Selective Nerve Root Block (SNRB): To be used for diagnosis/ testing only. It involves injection of dye (contrast) under x-ray guidance at a single nerve root. This is followed by injection of local pain medicine (anaesthetic), to see if you get pain relief. This is to be done only when/ for:
when your problem seems to be different from that shown on tests
Your tests show many areas/ levels of abnormality in the spine, and not sure which one is causing the problem.
previous surgery
surgery planning
A second one is only done if there are multiple spine level abnormalities, and the first one did not give enough relief, and it is scheduled at least a week after the first.
Epidural Steroid Injections (interlaminar-ILESI, Transformainal-TFESI, Caudal-CESI):
Epidural Steroid Injections (interlaminar-ILESI, Transformainal-TFESI, Caudal-CESI) : can be used for treatment. It involves injection of dye ( contrast) under x-ray guidance. This is followed by injection of steroid ( to decrease inflammation at pinched nerve) with or without additional local pain medicine (anaesthetic) into the epidural space. These can be done through different directions (interlaminar, transforamainal, caudal). This is to be done only when/ for:
no pain relief after medicines and 6 weeks of medically directed Exercises (including physical therapy, Doctor’s office given exercises or physical therapy), unless pain worsens, or your Doctor has a reason why they could not be done. This is needed even after failed back surgery.
Surgery planning
In association with draining a cyst that may be pressing on a nerve
Repeated injections for treatment :
are only typically needed if there has been >50% pain relief, increase in function/ activity or reduction in use of medicines or exercise services, for 2 months. These are typically done at interval of 2 months and typically do not exceed 4 ( rarely 6) / year
These injections should not be performed for/ when:
higher risk of bleeding due to being on certain medicines ( blood thinners), certain medical conditions etc; fracture; infection; spine (spinal canal) is blocked; if pain is thought to be from facet joint; uncontrolled diabetes and glaucoma; mostly functional ( psychogenic) pain; allergic reactions to substances used in injections; low blood volume. They should be cautiously used in multiple sclerosis.
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