Epidural steroid injection

Steroids are injected into the cerebral spinal fluid in the canal surrounding the spine. Nerves branch out from the spine. The nerve roots, which may be compressed, are at the base of the nerves.

Epidural steroid injection (ESI) is a technique for relieving pain from spinal stenosis and spinal disc herniation. Using a needle, corticosteroids and a local anesthetic are injected into the epidural space around the spinal cord and spinal nerves. The anesthetic gives short-term relief, and the corticosteroids give longer-term relief.^{[1]Need better WP:MEDRS source} The anti-inflammatory effect of the corticosteroid can relieve pain when that pain is caused by inflammation of the roots of the nerves branching out from the spine. There are risks to ESI, including death when the corticosteroids are infected, as in a 2012 meningitis outbreak.

ESI is controversial. Most studies conclude that pain relief from ESI's are short term and do not reduce the need for surgical intervention. While corticosteroids are approved by the U.S. Food and Drug Administration (FDA) for other uses, the FDA has not approved the use of corticosteroids for ESI.^[2]

Technique

Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated.^[3] Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.^[3] Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.^[3] While traditional techniques without image guidance, also known as "blind injections", can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.

References

1. Epidural steroid injections for lumbar spinal stenosis – Wed MD
2. PDR FDA DataSheets DepoMedrol / Kenalog | 2010
3. North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (North American Spine Society), retrieved 25 March 2013, which cites
   • North American Spine Society (2011). "Diagnosis and treatment of degenerative lumbar spinal stenosis". Burr Ridge, Illinois: Agency for Healthcare Research and Quality: 104.

External links

• Epidural Steroid Injections at KnowYourBack.org by North American Spine Society