Nerve root irritation has many different causes and these can include bulging disks, previous surgery that caused scar tissue formation, and degenerative changes of the spine and discs. It feels like an ache or burn from the lower back or buttock down the leg, often to the foot and toes.
One of the first and most conservative steps in the course of treatment for radiating pain is the use of epidural steroid injections at any level of the spine. The goal of the epidural steroid injection is to decrease inflammation at the nerve root level, and therefore, reduce the radiating or radicular pain associated with the nerve root irritation.
Epidural steroid injections can be performed at the cervical, thoracic, lumbar and even sacral region of the spine. Although, there are various techniques to inject the medicine into the affected area, these can essentially be broken down into the traditional mid-line translaminar approach and the transforaminal approach. The translaminar approach places the medicine inside the epidural space with the goal of having the medicine spread out toward the nerve roots themselves. The transforaminal steroid injection involves placing the medicine from the outside of the epidural space, with the goal of it tracking into the epidural space at specific levels.
Epidural steroid injections can be very effective in reducing the pain and often the numbness and weakness associated with nerve irritation. And, it is a much more conservative approach than surgical intervention.
As our goal with every patient and through every procedure is to treat the cause of the pain, rather than to mask the symptoms with various pain medications, Epidural Steroid Injections are a very safe and very effective means of treating the cause of radiating pain.
The traditional translaminar approach is often done in the office. X-ray guidance or fluoroscopy is not usually needed. When x-ray guidance is necessary, it is to confirm the level of placement of the medication, or to aid in special cases, such as when a patient has had prior surgery or spinal problems or deviations. On the other hand, transforaminal placement of epidural steroid medicine requires the use of fluoroscopy to help achieve more precise needle placement to ensure the safety of the procedure.
Typically, epidural steroid injections can be repeated up to three times within a six-month period. We do this to limit the patient’s exposure to steroids, which can produce unwanted side effects with high dosages. It is not uncommon for patients to return twice a year for a series of three epidural steroid injections if the injections significantly reduce their discomfort and allow them to maintain their quality of life in the face of otherwise debilitating pain.
Epidural Steroid Injections are very safe and very few complications have been reported with proper placement of the medication. The most likely, although extremely rare, complication is the possibility of infection. These procedures are done in a very sterile manner and in a very clean environment. To date, there have been no reported infections associated with Epidural Steroid Injections at the PRN Center. However, side effects from the steroids themselves are much more common. Although, side effects are rare, they do occur in approximately 10% of the patients receiving injections.
The most common side effects patients may experience after the administration of an epidural steroid injection are:
- Hyperactivity– patients feel sleepless for the first several nights and feel very energetic.
- Hypoactivity– patients feel lethargic, tired and drowsy.
- Headaches, night sweats and flushing.
- Temporary increase in appetite.
- Possible fluid retention.
- Temporary mood swings.
- Temporary increase in blood glucose levels (particularly in diabetic patients). All of these side effects generally dissipate within 2 to 3 days. If side effects are extremely severe, they can be treated with medications.