Epidural steroid injections are a commonly used treatment for many forms of low back, leg, neck and arm pain. This treatment method has been utilized since the 1950’s and offers a non-surgical option for management of the pain associated with both neck and lower back problems. The goal of the injections is to help alleviate pain and many times the numbness that frequently accompanies leg and arm pain. By itself, an epidural injection may be sufficient to provide relief but may also be used in conjunction with a comprehensive rehabilitation program for longer term benefit.
There are several methods that are used to perform an epidural steroid injection. This article will specifically discuss a mid-line or intralaminar approach.
When you feel someone’s spine you are pressing on part of the back called the bony vertebrae. There are three basic parts to our spine which are called the cervical (neck), the thoracic (chest) and the low back (lumbar). See Figure 1. Depending upon where your pain might be located an injection will be placed at the most appropriate level to provide the best relief. The injection will be placed into the epidural space which is the area surrounded by the bony vertebrae in the back and sides and the disc in the front. See figure 2. The epidural space contains the spinal and nerve roots that supply sensation and muscle control to our body. The neck area gives sensation to our arms and the low back gives sensation to our hips and legs. Initially our bony spine and discs provide protection to our spinal cord but with time and injury may start to irritate or compress the spinal cord and nerves causing many of our problems.
A intralaminar epidural injection is done by placing a needle between the bony vertebrae in the empty space that surrounds the spinal cord. This is the epidural space. Once the needle is in the correct location then medicine can be injected that will help reduce inflammation and pain. Most frequently a combination of steroids and local anesthetic will be used.
Before you have an epidural you will be examined and your physician may review images of your spine including an MRI, CT scan or X-rays. of your This will help determine the best location for your injection. After a discussion about the procedure including alternative treatments, risks and benefits you will be taken to the fluoroscopy suite for the procedure.
You will be placed flat on an x-ray table in a face down position. The table is padded and several pillows will be positioned to comfort you. The skin over the injection site will be cleaned with a surgical antibacterial soap. The area will be draped with a sterile barrier to minimize the chance for contamination. Using fluoroscopy (live x-ray) your spine will be examined and the proper location for the injection will be located. The skin will be numbed with a local anesthetic similar to what a dentist uses. Once again using fluoroscopy the needle will be guided into the epidural space and the location confirmed by injecting a contrast