The epidural space is the space between the bone and dural sac. The dural sac surrounds the nerve roots and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Uses of Epidural Steroid Injections (ESIs) - Mechanism

Epidural Steroid Injections are frequently used to reduce inflammation.There are often inflammatory factors and other substances that generate pain that are associated with a lumbar disc herniation. This inflammation can cause significant nerve root irritation and swelling.

Steroids can help reduce inflammation by inhibiting the production of substances that cause inflammation. The epidural steroid injection can be highly effective because it delivers the medication directly to the site of inflammation.

Indication

Epidural steroid injections are also used for rehabilitation. The procedure helps provide pain relief to enable patients to progress with their rehabilitation.

However, ESI’s are most commonly used for pain. Several common conditions—including a lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis—can cause severe, acute or chronic, low back pain and/or leg pain. For these and other conditions that can cause chronic pain, an epidural steroid injection may be an effective non-surgical treatment option.

Preparation for an ESI

• Do not eat or drink anything for three (3) hours prior to the exam.
• Small sips of water may be used to take routine medications.
• If you are diabetic, please follow your normal insulin schedule.
• Please contact one of our nurses (941) 917-1316 prior to your procedure if you take heparin, coumadin or plavix.

How does the procedure work?

The Radiologist will meet with you before the procedure to address any questions or concerns you may have.An epidural steroid injection usually takes between 15 and 30 minutes. The patient lies flat on an x-ray table on his/her abdomen. Prior to the epidural injection, the skin is numbed with a local anesthetic.

An interventional radiologist will perform the procedure. Using fluoroscopy (live Xray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space in order for the radiologist to verify precise needle placement throughout the procedure. Once the needle is in the exact position, the epidural steroid solution is injected.

After the Procedure

Following the injection, the patient is usually monitored for 15 to 20 minutes before being discharged to go home.

Sedation is available for patient anxiety and comfort; however, sedatives are rarely necessary, as the epidural steroid injection procedure is usually not uncomfortable. If a sedative is used, the patient will need to be monitored for a longer period following the injection.

Patients are usually asked to rest on the day of the ESI . Normal activities may typically be resumed the following day; however, the patient should avoid activities that will put a strain on the spine.

The Results

Because long acting, anti-inflammatory drugs are used in an ESI , it may take from 2 to 5 days before the initial effect of the medication is felt and 5 to 7 days before the maximum benefit is obtained; however, sometimes the relief is immediate.

Most ESI ’s are done in a series of three injections. There is usually a 7 to 14 day interval between injections.

As with any interventional procedure, you should discuss the benefits, risks and side effects of having an ESI with your physician.

To schedule an ESI , please call (941) 917-7322.