Epidural Steroid Injection
Medical Author:
William C. Shiel, Jr, MD, FACP, FACR
Medical Contributing
Author:
Standiford Helm II,
MD
Medical Editor:
Melissa Conrad Stöppler, MD
What is an epidural steroid injection?
An epidural steroid injection is a common procedure to treat spinal nerve
irritation that is caused by tissues next to the nerve pressing against it. The
beginning of the nerve (nerve root) is most often irritated by an
inflamed
intervertebral disc, or disc contents, directly touching the spinal nerve.
[Drawing of a disc herniation compressing the spinal nerve root]
An epidural steroid injection involves bathing an
inflamed nerve root in steroids (potent anti-inflammation medicine) in order to
decrease the irritation of the nerve root that is causing pain.
How is an epidural steroid injection performed?
The epidural steroid injection procedure is quick and simple. While it is
common for people to be concerned prior to the procedure, it is actually
frequent to hear from patients afterwards: "Is that all?"
The spinal cord rests in the spinal canal. The nerve roots branch out from
the spinal cord at each level of a spinal vertebra (the bony
building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a
shock absorber for the cord. The CSF is held in place by a membrane with
several layers, one of which is called the
dura, from the Greek
for tough (think of "durable"). The Greek word "epi" means "outside of." So, the
epidural space is outside of this tough membrane. During an epidural steroid
injection, a needle and syringe are used to enter the epidural space and deposit
small amounts of long-lasting steroids around the inflamed spinal nerve. A
fluoroscope (a viewing instrument using X-rays) is used to visualize the local
anatomy during the injection. The epidural steroid injection specifically
targets the inflamed area and treats it with a maximal amount of steroids,
thereby minimizing exposure of the rest of the body to the steroids.
[Epidural steroid injection with injection needle visible in the epidural
space using a fluoroscope)
When are epidural steroid injections used?
Epidural steroid injections are most commonly used in situations of
radicular
pain, which is a radiating pain that is transmitted away from the spine by an
irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes
pain that goes down the leg. Epidural injections are also
used to treat nerve compression in
the neck (cervical spine), referred to as
cervical radiculopathy.
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Last Editorial Review: 1/3/2007
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