Epidural Steroid Injections (Esi)

         Epidural steroid injections (ESI) are a minimally invasive procedure to help reduce inflammation and pain caused by nerve root compression. Nerve compressions are caused by herniated discs, bony prominences, or spinal stenosis. This causes symptoms such as pain, numbness or weakness along the nerve line called radiculopathy. If left untreated, these symptoms can last for days or even years.

              The purpose of an epidural steroid injection is to treat symptoms by helping to reduce inflammation along the nerve root. Medication applied to the epidural area contains triamcinolone, a corticosteroid such as dexamethasone, and a local anesthetic such as lidocaine. The drug is injected into the fat-filled area between the spinal bone, called the epidural space, and the protective layer of the spinal nerve. These injections are made to reduce pain. Thus, the normal activity and physical therapy program can be continued.

       Epidural Steroid injections are classified differently according to the area where they are made or the way they are administered. Epidural Steroids according to the injection site;

• Cervical epidural injections if applied to the neck area

• Thoracic epidural steroid injections if applied to the back area

• Lumbar epidural steroid injections if applied to the lumbar region

• If it is applied to the coccyx region, we can classify it as caudal epidural steroid injection.

Injections can also be classified according to the way they reach the epidural area;

• In interlaminar epidural steroid injection, the epidural region is reached by passing through the lamina and the injection is applied. It is the most commonly used form of injection.

• In the transforaminal epidural steroid injection, the needle is applied by reaching the epidural region in the region called the transforaminal where the nerve exits the spine.

                                          Why is it done?

        These steroid injections are used in patients with neck, arm, back, low back pain or sciatica. This treatment has proven beneficial for those with severe inflammatory conditions. Patients with the following conditions are candidates for epidural steroid injections:

• Spinal stenosis (Canal Stenosis): Narrowing of the spinal canal and nerve root canal

• Spondylolisthesis (Luminous Slipping): If a slip occurs between the vertebrae, it causes pain by compressing the nerve roots.

• Herniated Disc: The material inside the disc may protrude or tear through a weak area of ​​cartilage and come into contact with the spinal nerve.

• Degenerative disc: Fragmentation or aging of a vertebral disc causing the disc space to collapse or the growth of bony prominences.

• Sciatica: It is the compression of the nerves that causes the pain to enter the hips and legs.

       The doctor who will perform the procedure will review your medical history and previous imaging studies to plan the best approach for injections. Patients taking blood thinners (Coumadin, Plavix, etc.) should stop taking them a few days before the procedure. Coagulation or infection checks are performed by performing blood tests. You may also be asked to come to the procedure with a hunger for 4-5 hours.

        The procedure is a daily procedure that takes 15-45 minutes. The procedure is done in an outpatient center using fluoroscopy, which is usually X-ray. After the patient lies on a fluoroscopy table, local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains alert and aware during the injection with minimal sedation to provide feedback to the physician. After the procedure, the patient is discharged after 2-3 hours.

        Many patients benefit from ESI. Sometimes one to two more injections can be given, usually 1-4 weeks apart, to achieve the full effect. The duration of pain relief may vary from person to person, and may last for months or years. Injections are scheduled in conjunction with a physical therapy and/or home exercise program to strengthen spinal muscles and prevent future episodes of pain.

                 Risks associated with epidural steroid injections

       ESSI procedures have been practiced for many years and are considered a safe and effective treatment. Although rare, some patients experience side effects from the drug. Patients may experience a “steroid flush” with flushing of the face and chest, which may be accompanied by a low-grade fever. In addition, temporary sleep problems, hyperglycemia, hypertension, edema in the body (temporary water retention) and anxiety may be experienced.

         Serious complications are very rare, but can include conditions such as bleeding, infection, nerve damage, or contrast material allergy. When this procedure is performed with fluoroscopic guidance, the risk is minimized. In general, this type of procedure and injection is very well tolerated by most patients.