Epidural Steroid Injections for Lower Back Pain

If you are experiencing lower back and radiating nerve pain an Epidural Steroid Injection (ESI) may be an effective nonsurgical treatment option. Epidural steroid injections are powerful anti-inflammatories that reduce nerve inflammation at the disc nerve interface, "the source." Epidurals wash the nerve root in a mixture of steroid and local anesthetic to reduce swelling. They may hasten the recovery time by reducing nerve irritation and edema around the disc herniation. It is important to note however, that epidurals do not resolve disc herniation, they merely treat neuropathic pain caused by the herniation.

Your pain management specialist or physiciatrist, will use X-ray and contrast to safely and accurately inject the epidural.

Common reasons to utilize Epidural Steroid Injections include:

  • Commonly used to relieve back pain when a mechanical spine nerve irritation is the cause.
  • Used for exacerbations of radicular and nonradicular pain from nerve inflammation.
  • When combined with Physical Therapy and NSAIDs (non-steroidal anti-inflammatory drugs), Epdirual Steroid Injections can often delay or prevent surgical treatments.

Different Types of Epidural Steroid Injections:

  • Intralaminar Epidural Steroid Injection is the most common technique for large spread. It is commonly used to treat spinal stenosis for lower back pain. Given there is wide coverage, this is used for less specific areas. There is risk of dural puncture with this procedure.
  • Transforaminal Epidural Steroid Injection is used when placement is at a more specific level. The steroid is placed at the disc nerve interface. This type of epidural is used for selective acute radicular pain. There is a risk of transient neuritis with this procedure.
  • Caudal Epidural Steroid Injection is are given in the coccyx (tailbone or caudal) region to treat chronic lower back pain and chronic pain in the legs, an injection to the lowest part of the epidural space. A caudal steroid injection can help reduce lower back and leg pain caused sciatica, herniated discs, bone spurs or other back problems. Possible risks include bleeding or infection at the injection site or possibly a headache if the dura is punctured, which is unusual.

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