Epidural Steroid Injections

Epidural Steroid Injections

 

Should you get Epidural Steroid Injections?      It depends on the rationale for the treatment.  In my practice,  I use Epidural Steroid Injections for both treatment as well as diagnostic purposes.  The research for these injections have been significant, but the conclusions by the various authors have been very different.  If you must know,  there is controversy on the efficacy of the treatments.  Traditionally,  epidural steroid injections have been seen as a reasonable treatment option for patients with back pain and sciatica. But, now in the era of “cost effective” medical care,  the clinical benefits are measured against its costs to the system.  And,  as we know from the recent experience of contamination of the medications,  measured against the risks associated with epidural steroid injections.  A simple search of the internet will reveal many articles on the risks and benefits of the procedure.  Based on my experience,  epidural steroid injections definitely have a role in the treatment of patients with back pain and sciatica.

In theory,  epidural steroid injections benefit the patient by delivering corticosteroids to the areas of inflammation.  The steroids have a known anti-inflammatory effect, and will decrease the swelling to the tissues upon contact.  In a very simplistic way,  by decreasing the swelling,  the affected nerves in the spine will no longer have as much irritation.

Some practitioners also inject a volume of saline associated with the steroids,  and theorize that the volume of saline also flushes the area of painful chemicals that also lead to the inflammation.

In my practice,  I use epidural steroid injections when a patient has a sciatic, or nerve inflammatory complaint.  I believe the epidural steroid injections can help decrease the inflammation, and therefore reduce the pain.

For diagnostic purposes,  if the epidural steroid injections give even temporary relief,  it usually confirms that there is an irritant to certain nerves.  Based on temporary improvement, surgeons may consider the patient an appropriate candidate for surgery, as many practitioners use the so called transforaminal technique to try to isolate the specific nerve that may be causing the irritation.

There are certainly risks to the procedure, but in general,  epidural steroid injections can provide pain relief for certain patients, and can help isolate the cause of the spine pain.  Please discuss the details of the procedure with your physician.

Citations

  • Epstein NE. The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature. Surg Neurol Int. 2013;4(Suppl 2):S74-93. PubMed PMID: 23646278

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