An epidural steroid injection places this powerful anti-inflammatory medication directly around the spinal nerves. Traditionally epidural injections were administered without any special equipment, by inserting the needle by feel in the area around the spinal nerves. More recently epidural injections have been administered with the aid of imaging tools to allow your physician to see the needle going to the proper location. Either real-time x-ray called fluoroscopy, or CT scan can be used to 'watch' the needle deliver the medication to the proper location.
Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.
High dosages of oral corticosteroids taken daily for prolonged periods of time can have serious systemic side effects including bone loss ( osteoporosis), increased risk of infections and diabetes and cataracts, thinning of skin, stretch marks, increased facial/body hair growth, acne, fluid retention, weight gain with redistribution of fat (fat deposits on back and face, thinning of limbs), muscle weakness, decreased resistance to infections, stomach ulcers, mood swings, insomnia, suppression of the body's own production of cortisol, etc.