Epidural Spinal Injection Therapy

Epidural injections are most effective in the presence of nerve root compression. (Epidural - Space outside the dura or covering of the spinal cord. This space runs the length of the spine). The most commonly performed injection is an epidural steroid injection. In this approach, a steroid is injected directly around the dura, the sac around the nerve roots that contains cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Scientific studies often demonstrate inflammation of the spinal nerves following prolonged compression, which leads to irritation and swelling. This irritation occurs at the level of the root of the lumbar nerves. The injection of steroids, which are potent anti-inflammatories, is made into the epidural space, close to the affected nerve roots. These injections must be given by experienced specialists who are well trained in this technique. Improvement of the symptoms appears to correlate well with the resolution of the nerve root inflammation. These injections are most effective when given in the first weeks of the onset of pain. Usually, two to three injections one to two weeks apart are required. Only a single injection is given if complete pain relief is achieved.

Doctors limit the number of epidural steroid injections to a maximum of three to avoid systemic side effects of the steroids. Side effects are minimal and consist mainly of mild tenderness in the area of injection which disappears in 1-2 days. Success is dependant on the cause of the pain and how long the pain has existed. The sooner the treatment is instituted, the better are the chances of getting well. This treatment, along with analgesics and physical therapy has brought relief to thousands of patients, avoiding, in the majority of cases, the need for surgery. Prior to the injection, the skin is anaesthetized by using a small needle to numb the area in the low back (a local anaesthetic).

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