Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.
Epidural Injections have been used since 1952 and are recommended for diagnostic and therapeutic purposes. This type of injection is normally considered after nonsteroidal anti-inflammatory drugs and/or physical therapy have failed to provide adequate pain relief. Epidural Injections have been proven to be effective in relieving pain. For those who receive the injection within three to six months from the onset of pain, response rates can be as high as 70-90%. This response rate may lower for patients who have had prolonged pain. Other factors associated with a decreased response include age over 60 years, smoking, and a history of back surgery.