Epidural Steroid Injection (ESI) is a commonly used procedure to treat pinched nerve, degenerative disc disease, disc herniation or spinal stenosis. Epidural steroid injection should be only done by highly trained physicians using fluoroscopic guidance. During this procedure your doctor will identify the source of pain and administer steroid (cortisone) with local anesthetic in to the area of pain generator. Injection of steroid into the area of pain helps to decrease pain and inflammation.
Epidural steroid injections can be done in the neck (cervical epidural steroid injection), mid back (thoracic epidural steroid injection), low back (lumbar epidural steroid injection) or through sacral hiatus (caudal epidural steroid injection).
There are also different techniques or epidural steroid injections. Interlaminar epidural steroid injections are more basic epidural steroid injections, when the needle is entered into the epidural space between two vertebra through a space called inter laminar space. This kind of epidural steroid injection is not specific, medication will likely spread on both sides of the vertebra and may flow 1-2 vertebra up or down. This kind of epidural may be beneficial for certain patient and conditions.
The other technique of epidural steroid injection is called transforaminal epidural steroid injection or nerve root block. This is a more specific technique of epidural steroid injection and requires highly trained and skilled physicians to do it. This technique of epidural steroid injection is commonly used when a specific nerve root is targeted, and can have both diagnostic and therapeutic value. With this technique, your doctor will administer small amount of numbing medication and steroid around a specific nerve root coming out of the spinal cord. Transforaminal epidural steroid injections are more commonly used for radiculopathy (also known as sciatica).
Caudal epidural steroid injection may be recommended by your doctor for specific conditions and may be preferred technique for patients with prior back surgeries such as fusion surgery or for patients with more symptoms in the buttock, sacrum or coccyx area.