DIAGNOSIS
Who is Qualified?
You are qualified for an epidural steroid injection if conservative therapy has failed in treating your problem. If you’re also not a candidate for surgical intervention, you can be considered for this procedure to relieve you from radicular pain caused by disk herniation temporarily.
TREATMENT
Indications and Contraindications of Epidural Injections:
Epidural injections are used for the diagnosis and treatment of radicular pain with or without radiculopathy. This is sometimes also given to patients with axial spine pain and neurogenic claudication.
The spinal nerve that needs to be targeted is selected according to clinical and neurophysiologic findings and imaging synthesis. A prerequisite for epidural injection includes advanced spinal imaging with MRI, plain CT-scan, or CT-myelography.
The pre-procedure imaging is necessary because it can help plan out the injection route to be able to optimize the delivery of medication to the epidural space and decrease risk to the neural or vascular structures. Local anesthetics are given for diagnosis.
How Epidural Injections are Carried Out
Interlaminar epidural steroid injection is given in the lower cervical, thoracic, and lumbar spine while the patient is in a prone position. This epidural injection is administered without sedation and with fluoroscopic guidance.
Caudal epidural injections are given via the sacral hiatus.
The transforaminal procedure is given without sedation while the patient is either in a supine or prone position. In this procedure, a patient is given both local anesthetic and a corticosteroid. This procedure has limited diagnostic use. A patient’s vital signs, pain level, and neurologic status are monitored continuously while undergoing this procedure.
The decision to have an injection repeated should be based according to a patient’s response to the previous injection. It should be noted that most patients do not require repeated injections.
The North American Spine Society (NASS) suggests that if a patient would need more than four injections in one year, alternative treatment and surgical intervention should be considered.
Risks and Benefits
The risk of epidural injections is greater in the cervical spine area. The risks include allergic reaction to the medications, dural puncture, radiation exposure, needle injury to the neural or vascular structures, and infection like an abscess.
Having multiple corticosteroid injections may worsen osteoporosis and suppression of the hypothalamic-pituitary-adrenal axis.
On a more positive note, having an epidural steroid injection can help relieve pain, achieve functional recovery, avoid surgical intervention, identify the patient’s pain generator, and prevent discectomy.
