The epidural space is between the dural sac (a membrane encasing the spinal cord, spinal fluid and nerve roots) and the vertebral wall, inside the spinal canal but outside the nerve sac. An epidural steroid injection (ESI) is an injection that delivers long-acting steroids directly into the epidural space. The steroids help to reduce pain by reducing inflammation around the nerves. Sometimes an anesthetic or saline is also used to help “flush out” inflammatory agents that may be irritating a nerve.
Epidural steroid injections are typically used to treat pain radiating from the lower back into the legs or from the neck into the arms. The diagnoses most often considered for ESI are herniated disc, stenosis, nerve root compression and, in some cases, spondylolisthesis.
Once you have decided to have the injection, the following events take place:
An epidural steroid injection usually takes between 15 and 30 minutes.
ESI are performed in either a hospital or ambulatory surgery center (ASC) using x-ray guidance. After the skin is carefully cleaned and numbed with a local anesthetic (similar to what dentists use to numb the gums to fill cavities), a needle is carefully introduced into the spinal canal. After the needle placement is confirmed with the x-ray, often confirmed by a small amount of dye, the ESI is administered.
The whole procedure only takes approximately 10-20 minutes to perform, but patients are then monitored for a short period of time before going home.
Typically ESI are not very painful procedures. Local anesthetics are used to minimize the discomfort from the needle. Sedation can also be used to reduce pain and make the patients more comfortable during the procedure, especially if they are nervous.
ESI are performed at Texas Back Institute by fellowship-trained, board-certified spine surgeons and physical medicine and rehabilitation specialists.
The general guideline is that a person can have up to 4 epidural steroid injections per year. If a patient gets excellent results with just one or two, then additional injections may not be needed. Every patient’s response is different.
Most major medical insurance plans, including Blue Cross/Blue Shield, United Healthcare, Aetna, Cigna, and Medicare, cover ESI, but they are still subject to the same deductible and co-payments as other health care procedures.
For some patients, if a patient does not get adequate relief with a steroid injection, surgery may be an alternative. Certainly, the decision to have surgery and the type of surgery is a very personal one made on a case-by-case basis between the surgeon and the patient. At Texas Back Institute, we pride ourselves on delivering personalized treatment plans for each patient so that they are getting the most effective, most cost-conscious care possible.