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Spinal injections have proven to be an effective option for managing spine conditions. Injections are used to:
An epidural steroid Injection (ESI) is an outpatient procedure in which a steroid (an anti-inflammatory medicine) is injected into a very precise area of the epidural space of the spine, using continuous X-ray guidance (fluoroscopy).
ESI relieves pain in the arms and legs caused by an irritated nerve root.
ESI is used to reduce any inflammation that may be present in a spinal nerve root.
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.
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.
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.
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.
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.
Another advantage of transforaminal ESI is that the doctor can also inject lidocaine — a numbing medication — that works immediately (but temporarily) to 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.
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.
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.
Your spine is made of ring-shaped bones called vertebrae.
The "rings" at the center of each vertebrae line up to form a column in your back, the spinal column.
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.
A membrane called the dura mater covers and protects the spinal cord.
The small area surrounding the dura mater is called the epidural space.
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.
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 2nd Floor
330 Brookline Avenue
Boston, MA 02215
Read All About Your Spinal Injection for comprehensive information about your injection at our Spine Center (PDF)
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