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Epidural Steroid Injections

Epidural Steroid Injections

The epidural space lies in between the bony canal in your spine and the spinal cord. There are five portions of your spine, the neck (cervical), mid back (thoracic), low back (lumbar), pelvis (sacrum), tailbone (coccyx).  The epidural space runs the length of the spine and contains the spinal cord and exiting spinal nerves.  The nerves can be irritated by many sources as they travel through the epidural space, including compression from herniated discs, degenerative changes involving the spinal ligaments, discs, facet joints, bone spurs, and malalignment of the spine.  As a result of  irritation, inflammation, injury to a spinal nerve, the spinal nerve roots can become a significant and disabling source of pain.

Epidural steroid injections (ESIs) have been used as a non-surgical way to treat low back and neck pain. These procedures typically involve the injection of a solution containing corticosteroids and/or anesthetic into the epidural space.  

The ESI can be performed in three ways. 

Interlaminar (ILESI) approaches the epidural space from the midline back-side of the spine through the opening in between two bones of your spine called the ‘interlaminar window’. 

In the transforaminal approach (TFESI), the injection is done at the openings on either side of the spinal column where nerves exit the spine.  The caudal approach (caudal ESI) enters through the sacral hiatus at the sacral canal to access the epidural space.

Sometimes a surgeon will request a “selective nerve root block”.  These are usually anesthetic only injections performed around a single spinal nerve to help identify the source of your pain.  

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