|Nerve root irritation has many different
causes and these can include bulging disks, previous surgery
that caused scar tissue formation, and degenerative changes
of the spine and discs. It feels like an ache or burn
from the lower back or buttock down the leg, often to
the foot and toes.
One of the first and most conservative steps in the course
of treatment for radiating pain is the use of epidural
steroid injections at any level of the spine. The goal
of the epidural steroid injection is to decrease inflammation
at the nerve root level, and therefore, reduce the radiating
or radicular pain associated with the nerve root irritation.
Epidural steroid injections can be performed at the cervical,
thoracic, lumbar and even sacral region of the spine.
Although, there are various techniques to inject the medicine
into the affected area, these can essentially be broken
down into the traditional mid-line translaminar approach
and the transforaminal approach. The translaminar approach
places the medicine inside the epidural space with the
goal of having the medicine spread out toward the nerve
roots themselves. The transforaminal steroid injection
involves placing the medicine from the outside of the
epidural space, with the goal of it tracking into the
epidural space at specific levels.
Epidural steroid injections can be very effective in reducing
the pain and often the numbness and weakness associated
with nerve irritation. And, it is a much more conservative
approach than surgical intervention.
As our goal with every patient and through every procedure
is to treat the cause of the pain, rather than to mask
the symptoms with various pain medications, Epidural Steroid
Injections are a very safe and very effective means of
treating the cause of radiating pain.
The traditional translaminar approach is often done in
the office. X-ray guidance or fluoroscopy is not usually
needed. When x-ray guidance is necessary, it is to confirm
the level of placement of the medication, or to aid in
special cases, such as when a patient has had prior surgery
or spinal problems or deviations. On the other hand, transforaminal
placement of epidural steroid medicine requires the use
of fluoroscopy to help achieve more precise needle placement
to ensure the safety of the procedure.
Typically, epidural steroid injections can be repeated
up to three times within a six-month period. We do this
to limit the patient's exposure to steroids, which can
produce unwanted side effects with high dosages. It is
not uncommon for patients to return twice a year for a
series of three epidural steroid injections if the injections
significantly reduce their discomfort and allow them to
maintain their quality of life in the face of otherwise
Epidural Steroid Injections are very safe and very few
complications have been reported with proper placement
of the medication. The most likely, although extremely
rare, complication is the possibility of infection. These
procedures are done in a very sterile manner and in a
very clean environment. To date, there have been no reported
infections associated with Epidural Steroid Injections
at the PRN Center. However, side effects from the steroids
themselves are much more common. Although, side effects
are rare, they do occur in approximately 10% of the patients
The most common side effects patients may experience after
the administration of an epidural steroid injection are:
• Hyperactivity-- patients feel sleepless for the
first several nights and feel very energetic. •
Hypoactivity-- patients feel lethargic, tired and drowsy.
• Headaches, night sweats and flushing. •
Temporary increase in appetite. • Possible fluid
retention. • Temporary mood swings. • Temporary
increase in blood glucose levels (particularly in diabetic
patients). All of these side effects generally dissipate
within 2 to 3 days. If side effects are extremely severe,
they can be treated with medications.