Epidural Steroid Injections

• There are three common methods for delivering steroid to the epidural space; transforaminal, interlaminar, and caudal. All three approaches use fluoroscopic (x-ray) guidance. Oftentimes, we utilize contrast dye to confirm that the medication is traveling in the desired area.
• A transforaminal approach places the medication alongside the nerve as it exits the spine. This is a more targeted approach, placing a higher concentration of medicine in a smaller area. The transforaminal injection can be slightly modified to help your surgeon isolate a single segment called a nerve root block. This is to provide diagnostic information in addition to pain relief about specific segments of the spine.
• An interlaminar epidural is when the needle travels to the back side of the spinal canal, delivering the medicine over a wider area.
• A caudal approach accesses the epidural space from the bottom of the spine at an opening called the sacral hiatus. This is to spread a large volume of medication over several spinal segments on both sides of the canal. This is the least targeted approach and only effective for lower back and leg symptoms, not for neck or arm pain.

At Virginia Spine Institute, the decision to perform additional injections is made only after careful observation and follow up regarding how prior injections have impacted your pain and quality of life. We usually do not prescribe a series of injections.

Your body makes its own internal steroid called cortisol. This natural steroid has various functions, some of which include regulating metabolism and helping reduce inflammation. When you combine cortisol with the artificial steroids you take, too many steroids in your body can be harmful. High levels of steroids can artificially affect various bodily functions such as: causing high blood pressure, high blood sugar levels, lowered immune system, and low bone density. That being said, “too much” means constant regular doses, orally or injected.

Like most things in life, moderation is the key. A limited number, or amount, of steroids can be used very effectively to help you with your overall quality of life. When used appropriately and judiciously, steroids are very efficient in treating many pains associated with inflammation.

The goal is to use steroid injections as one part of a comprehensive treatment plan. By reducing pain and inflammation, you are able to participate in further preventative treatments such as physical therapy and rehabilitation. This will help to strengthen and increase your range of motion. Steroid injections are less beneficial when used alone, and tend to lead to recurrent pain and repeat injections beyond safe amounts.

There is very minimal pain while receiving an injection. The local anesthetic in your injection acts to temporarily numb the area being injected.