Spinalogy Blogs

If you suffer from the searing pain of sciatica radiating down your leg, you know how debilitating this condition can be. Sciatica occurs when the sciatic nerve becomes irritated or compressed, often due to a herniated disc, spinal stenosis, or degenerative disc disease in the lumbar spine. While conservative treatments like pain medication, physical therapy, and lifestyle modifications can help manage symptoms, some patients require a more targeted approach. This is where epidural steroid injections come in.

What are Epidural Steroid Injections? 

Epidural steroid injections (ESIs) involve injecting a corticosteroid medication and local anaesthetic directly into the epidural space surrounding the spinal cord and nerve roots. The goals of ESIs are to:

1. Reduce inflammation and irritation of affected nerve roots
2. Alleviate pain in the lower back and legs
3. Improve mobility and function
4. Facilitate progress in a comprehensive​ rehabilitation program

Steroids​ work by decreasing the production of​ inflammatory chemicals and reducing nerve fibre sensitivity to pain signals. By delivering medication directly to the source of inflammation, ESIs can provide ​targeted pain relief.

When​ are ESIs Indicated for Sciatica? 

ESIs are typically considered to provide adequate symptom​ relief. They are commonly used to treat sciatica caused by:

• Lumbar herniated discs
• Degenerative disc disease
• Spinal stenosis

In some cases, ESIs may also be used for localised back pain (axial pain) or neurone​nic claudication - pain that ​occurs while walking due to nerve compression.

The decision to proceed with an ESI should be made in collaboration with a spine s​specialist, considering the patient's specific diagnosis, symptom severity, and overall health. 

Injection Techniques 

There are three main approaches for administering​ ESIs:

1. Trans​foraminal: The medication is injected into the epidural space near the a​ffected nerve root​(s). This targeted approach is useful for treating specific areas of nerve inflammation.
2. Interlaminar: The needle enters the epidural space from the back of the spine, allowing medication to spread within the space. The entry is between two laminae, which is why it is called an interlaminar epidural injection. 

3. Caud​al: Medication is injected into the epidural space through the caudal (tailbone) route. Fluoroscopic ​(x-ray) guidance is often used to ensure accurate needle placement and minimize risks.

Efficacy of ESIs for Sciatica 

Studies have shown that 70-90% of patients experience pain relief from ESIs, with​ ​effects lasting anywhere from a week to a year. While the long-term efficacy remains controversial, ESIs can provide significant benefits.

Patients​ who respond well to an initial injection may receive up to three injection​s over 12 months. ​The goal is to achieve enough pain relief to facilitate active participation I​n physical therapy and multidisciplinary therapies, which are crucial for long-term recovery.

Potential Risks and Side Effects 

While ​generally considered safe, ESIs do carry some risks. Common temporary side effects may includ​e:

• Post-injection pain
• Nausea
• Headache
• Dizziness
• Fainting
• Facial flushing

Injections below the L4 level generally carry lower risks compared to higher spinal levels.

Certain medical conditions may preclude the use of​ ESIs, such as:

• Infections
• Tumors
• Bleeding disorders
• Uncontrolled diabetes
• Certain heart conditions
• Pregnancy

Patients should​ discuss their complete medical history with their doctor to determine if ESIs are appropriate an​d safe for their situation.​

The Injection Procedure 

ESIs are typically performed in an outpatient setting by a​ spine or pain management specialist. The procedure usually takes about 30 minutes and involves the following steps:

1. An IV li​ne may be started to administer relaxation​and medication if needed. Most patients remain​ conscious during the injection.
2. The skin and deeper tissues over the injection site are numbed with Lo​cal anaesthetic.
3. Using fluoroscopic guidance, the physician directs a needle into the epidural space and injects ​contrast dye to confirm proper placement.
4. The steroid medication and anaesthetic are slowly injected. Patients may feel pressure, tingling​, or mild discomfort at this point.
5. The needle is removed, and the procedure is complete. Patients are monitored for a short time before being discharged home. In some cases, IPD monitoring is required. 

In the following days, patients should follow post-price​dure precautions as directed by their doctor. Pain relief may​ be noticed within a few days, although i​t can take up to 2 week​s for the full effects to manifest.

Is an ESI R​ight for You? 

With the right approach and expert guidance, epidural steroid injections can be a​ valuable tool in managing the complex challenge of sciatica and improving your overall quality of​ life. If you think you may be a candidate, don't hesitate to speak with y​our healthcare provider about​ this option.