Epidural Steroid Injections

 

Did your doctor schedule you for an epidural steroid injection?  Whether they did or you are just looking for some information, you will hopefully feel more informed after reading this.  

    

Let's review the anatomy first.  The spine is made up of 33 vertebrae that stretches from the base of the skull down to the pelvis.  It consists of 5 zones.  When doctors are speaking of the "spine" they are usually referring to the upper three areas, which are the cervical, thoracic and lumbar vertebrae.  There are 7 vertebra in the cervical region, 12 vertebrae in the thoracic region, and 5 vertebrae in the lumbar region.  Some people may have a 6th vertebrae in the lumbar region, or one that is fused to the sacrum; these are considered normal variants.

 

The sacrum is below the lumbar region in the pelvis and it is made of 5 fused bones.  The coccyx is attached to the bottom of the sacrum by the sacrococcygeal ligament and it is made up of four vertebra.  The second, third and fourth coccygeal vertebra are fused.  

 

Each vertebra is made of a vertebral body and an arching of two pedicle and two lamina bones which end at the spinous process.  These bones form a ring with a hole in the center and form the spinal canal when the vertebra are in place.  Inside the spinal canal is the epidural space and dural sac, which holds the spinal column and cerebrospinal fluid.  

 

The vertebra are stacked on top of each other, with an intervertebral disc in between.  The discs act like shock absorbers between the bones and can be a source of pain if worn out or traumatized.  

 

You should first know that the epidural space runs from the base of the skull down to the sacral hiatus.  Can be approached between the vertebra from the back or from the side foramen where the nerves exit the spine.  

 

An epidural steroid injection is when medication, usually steroid and local anesthetic, is placed in the epidural space to relieve pain.  It can be very effective for back and leg pain due to a pinched nerve or inflamed nerve.  The effects can be temporary or permanent and usually depends on the cause of the pain.  If the pain is due to chemical irritation of the nerves, then it can be very effective in elimination of the pain.  If the pain is caused by a mechanical compression or arthritis, then the effects may be temporary.  Most of the time, adjuvant therapy is necessary as well, such as physical therapy.