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Spinal Injections

Effective for Managing Spine Conditions

Spinal injections have proven to be an effective option for managing spine conditions. Injections are used to:

  • Reduce pain
  • Increase mobility
  • Avoid or delay the need for surgery

What is an Epidural Steroid Injection (ESI)?

An epidural steroid Injection (ESI) is an outpatient procedure in which a steroid (an anti-inflammatory medicine) doctor's hand holds in position a needle for a patient's epidural steroid injectionis injected into a very precise area of the epidural space of the spine, using continuous X-ray guidance (fluoroscopy).

Benefits of ESI

Relieves Pain

ESI relieves pain in the arms and legs caused by an  irritated nerve root.

Reduces Inflammation

ESI is used to reduce any inflammation that may be present in a spinal nerve root.

Helps Determine Cause of Symptoms

ESI is useful in both the diagnosis and treatment of certain spine conditions. By placing the medication in a precise area and monitoring the patient's response, valuable information is gained about what nerves may or may not be involved in causing the symptoms, and how to target appropriate treatment for pain relief. 

What to Expect During an ESI

  • The patient will lie face down on a table.
  • Numbing medicine will be injected into the patient's back.
  • Contrast dye will be injected into the area so that the structures of the spine will be visible on X-ray.
  • Using X-ray guidance, the doctor then places the steroid medication into the precise area of the patient's back believed to be causing the problem.

An epidural steroid injection takes about 15 minutes. The patient is then observed for 20 to 30 minutes before going home. The arms or legs can be weak immediately after the procedure because of the numbing medication, so patients are asked not to drive themselves home and to take care when moving about for the rest of the day.

How Long Does ESI work?

  • Many patients who undergo ESI have a significant decrease in arm or leg pain.
  • It can take a few days for the effects of a spinal ESI to be known; however, if the pain gets better, the effects usually last about six to 12 weeks.
  • If needed, an ESI can be repeated. Patients who do get better may not experience complete pain relief; a realistic goal is to achieve a major reduction in the level of pain.

Common Misconceptions About ESI

Frequency

There is no maximum number of ESI treatments. Some patients get relief after one or two treatments, others need additional injections. Your doctor will discuss with you how many treatments you may need.

ESI vs. Epidural Anesthesia

An epidural steroid injection is not the same thing as epidural anesthesia used during childbirth or certain surgeries.


An ESI does not involve multiple needle sticks to the back. Unlike epidural anesthesia, ESI is done under X-ray guidance, allowing the doctor to see exactly where to place the injection, which eliminates the need for multiple sticks.


Headaches and other complications sometimes seen with epidural anesthesia are rare following ESI.


Please be sure to discuss all questions and concerns about epidural steroid injections and your spine care with your doctor.

A transforaminal epidural steroid injection (ESI) is an advanced technique for spinal injections, in which medication is given to a very specific area of the spine.

 

 

Advantages of Transforaminal ESI

Reducing Pain

Transforaminal ESI may better the chances of reducing a patient's arm or leg pain that is caused by nerve problem in the spinal column. The main advantage of transforaminal ESI is that the doctor can deliver the medicine into the neural foramen that contains the actual nerve root in question, which can increase the likelihood of successfully reducing the patient's back pain.

Ensures Focus on Correct Nerves

Another advantage of transforaminal ESI is that the doctor can also inject lidocaine — a numbing medication — that works immediately (but temporarily) Dr. Stefan Muzin uses imaging to guide a patient's transforaminal epidural steroid injectionto numb the nerve root. If the numbing medication immediately relieves the patient's pain, the physician then knows that the correct area of the spine has been reached. This can help ensure that additional steroid injections or potential surgery focus on the correct nerves.

Considerations

Spine injections should only be done by doctors with special training. Before the ESI procedure, the doctor will get detailed pictures of the spine using MRI or CT scan, which will help determine the best approach.

What to Expect During a Transforaminal ESI

  • The patient will lie face down on a table.
  • Numbing medicine will be injected into the patient's back.
  • Contrast dye will be injected into the area so that the structures of the spine will be visible on X-ray.
  • Using X-ray guidance, the doctor then places the steroid medication into the precise area of the patient's back believed to be causing the problem.

The transforaminal ESI takes about 15 minutes. The patient is then observed for 20 to 30 minutes before going home. The arms or legs can be weak for a brief time after the procedure because of the numbing medication, so patients are asked not to drive themselves home and to take care when moving about for the rest of the day.


Patients may have slight discomfort for a few days after the injection, before they begin to feel the benefits of pain relief.

How Long Does ESI work?

  • Many patients who undergo ESI have a significant decrease in arm or leg pain.
  • It can take a few days for the effects of a spinal ESI to be known; however, if the pain gets better, the effects usually last about six to 12 weeks.
  • If needed, an ESI can be repeated. Patients who do get better may not experience complete pain relief; a realistic goal is to achieve a major reduction in the level of pain.

Please be sure to discuss all questions and concerns about epidural steroid injections and your spine care with your doctor.

Vertebrae

illustration showing the spine, from brain to lower backYour spine is made of ring-shaped bones called vertebrae.

Spinal Column

The "rings" at the center of each vertebrae line up to form a column in your back, the spinal column.

Spinal Cord

The spinal cord extends from the base of the brain and ends at the upper lumbar spine, continuing further down as a large bundle of nerves through the lower part of the spinal column.

Dura Mater

A membrane called the dura mater covers and protects the spinal cord.

Epidural Space

The small area surrounding the dura mater is called the epidural space.

Nerve Roots

Branches of nerves from the spinal column (nerve roots) pass through the spinal canal and extend into the back, arms, and legs. If something is irritating the nerve roots (such as an abnormality in one of the vertebrae or discs), pain can be felt in the back and all along the nerve.

 

 

Contact Information

Spine Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 2nd Floor
330 Brookline Avenue
Boston, MA 02215
617-754-9000
spinecenter@bidmc.harvard.edu

All About Your Spinal Injection

All About Your Spinal Injection (PDF)
Read All About Your Spinal Injection for comprehensive information about your injection at our Spine Center (PDF)


Watch our videos that provide further detailed information about having a spinal injection at our Spine Center