Candidates For Epidural Steroid Injections

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The most widely used intervention for acute disk herniation with nerve root impingement is the epidural steroid injection. This herniation often leads to the development of radicular pain. ‘Radicular’ comes from a Latin derivative of the word ‘root’, hence, it refers to an irritation of the nerve root. The epidural steroid injection is also used for a variety of spine related disorders including disk herniations, spinal stenosis, degenerative disk disease, spondylosis, spondylolisthesis, and sciatica. The epidural space is the space surrounding the spinal cord and nerve roots as they exit the spinal canal, traversing nearby the disks, before exiting out the bony foramen on their journey to the periphery. These injections can be given via various roots: Caudal, translaminar or transforaminal. The injection is usually given under fluoroscopic x-ray guidance, to assure the needle is in the proper location. Contrast is often used, which acts like a dye that is visible under X-ray, to watch for flow of medication into the targeted pathological area of concern. Epidurals associated with causing paralysis and permanent nerve damage are much more a myth than reality. The epidural steroid injection may function by two different mechanisms: decreasing swelling and irritation of the disks and nerve roots, as well as washing away inflammatory substances that may exist in the epidural space.  Local anesthetic is often injected in combination with steroid. The local anesthetic effect we will give pain relief immediately while the steroid benefit may take several days or up to one week to fully be beneficial.



Gary Saff

Gary Saff, MD

Interventional Pain Management Specialist

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