Epidural Steroid Injections

Epidural steroid injection (ESI) is a nonsurgical treatment designed to relieve low back, neck, arm and leg pain (sciatica). This pain is caused by the irritation of spinal nerves. ESIs can relieve pain caused by disc herniation, spinal stenosis, spondylolysis and spondylolisthesis. The goal is to reduce pain so that patients may resume their normal activities and, in some cases, start or continue with physical therapy. The ESI delivers a long-lasting steroid and an anesthetic agent to the irritated, inflamed spinal nerve.

ESI’s effects vary

Most patients who are good candidates and carefully selected will get long-lasting relief from steroid injections. ESIs can relieve symptoms caused by inflammation and pressure on spinal nerves. ESI includes both a corticosteroid and an anesthetic. These drugs are delivered into the epidural space between the protective covering of the spinal cord and the vertebrae. Corticosteroids can reduce inflammation and pain when delivered directly to the source of back or neck pain. There are two types of ESIs:

Interlaminar : Placed between the lamina of two vertebrae from the back. This approach allows medication to spread through the epidural space. Interlaminar injections are not nerve root-specific.

Transforaminal injection /Selective nerve root blocks: An approach for injecting therapeutic medications around nerve roots at the exact site of inflammation. This technique also allows medication to enter the epidural space through the foramen.

Candidates for ESI

Patients with pain or radiculopathy in the low back, neck, arm or leg may benefit from ESI if they present with the following conditions:

Herniated disc: When the gel-like middle of an intervertebral disc squeezes from the center and touches a nerve, pain can result.

Spinal stenosis: Narrowing of the spinal and nerve root canals most often due to osteoarthritis. This causes back and leg pain, especially when the patient is walking.

Radiculopathy: When a nerve root does not work properly, numbness, weakness, referred pain or difficulty controlling specific muscles may result.

Spondylolysis: This is a weakness or fracture to the upper and lower facets of a vertebra. The resulting instability can also cause pain.

Spondylolisthesis: When a spinal vertebra slips forward, it is called spondylolisthesis. This condition can lead to compressed nerve roots and pain. When the patient’s symptoms interfere with therapeutic exercise, ESI can reduce pain enough to help patients undergo physical therapy and rehabilitation.

Dr. R. Alan Moore, Jr., is a board-certified anesthesiologist and pain specialist who uses ESI and other types of injection therapy to treat selected pain patients. Perhaps he can help your patients, too. He encourages and welcomes your ESI referrals.

To schedule an appointment, please call our office at 713-664-2662 or use our online Request an Appointment form. For additional information on any condition, treatment or procedure, please visit our Health Education Library.