Epidural/Caudal Steroid Injections
Epidural nerve blocks are corticosteroid injections which are used to decrease pain and inflammation caused by a herniated disc, sciatica, or spinal stenosis. Safe and effective, this treatment option may offer you substantial relief without surgery. The most common reason for an ESI to be performed is a herniated disc. These disc herniations can cause irritation and inflammation in the immediate area of the spinal cord and/or nerves- thus, producing the well-known symptoms of “Sciatica”.
An epidural nerve block is the injection of corticosteroid medication into the epidural space of the spinal column. This space is located between the dura (a membrane surrounding the nerve roots) and the interior surface of the spinal canal formed by the vertebrae. Typically, these procedures are utilized to deliver the steroid medication as close as possible to the actual source of your pain.
After a local skin anesthetic is applied to numb the skin over the injection site, a spinal needle is inserted into the epidural space. To ensure accuracy and safety, our physicians perform the procedure under fluoroscopic (x-ray) guidance, using a contrast agent to confirm needle placement. Local anesthetic and corticosteroid anti-inflammatory medication are delivered into the epidural space to decrease the swelling around nerve roots, relieving pressure and pain.
Before the Procedure, it is very important that you do not eat anything at all at least 12 hours (or do not drink anything at least 3 hours) before your procedure. Epidural nerve blocks are performed on an outpatient basis. This procedure typically requires 20 to 30 minutes, including preparation time.
Up to three injections may be given within a 6 month time frame. Usually, the injections are performed one to three weeks apart. A set of three injections is usually scheduled; however, you may gain considerable relief after the first or second injection. In that instance further injection may not be necessary.
Epidural nerve blocks are very effective in providing pain relief. The benefit from these injections will typically occur two days following the procedure. In conjunction with physical therapy, many individuals enjoy a pain free lifestyle. I like to tell patients that these ESIs are to be used “as a bridge to therapy”, thus, assisting them in decreasing their pain and discomfort enough to tolerate the therapy, weight loss, smoking cessation, core/abdominal strengthening, and hamstring flexibility exercises required for them to get better. Thus, the outcome of the procedure (whether it “works or not”) will be measured by your level of functioning, not necessarily in a reduction of your pain level.