Patients have benefited from epidural injections since they were invented back in the 1950s. They can provide excellent pain relief for conditions such as sciatica or radiculopathy from herniated discs, along with symptoms from spinal stenosis compressing nerves.
Epidural injections work exceptionally well which is why they have remained in steady use over the past 60 years. The success overall of epidural injections has exceeded 75% consistently in research studies. The absolute best results with epidural injections are obtained when the patient has other treatment options as well including chiropractic treatment, spinal decompression therapy, physical therapy, acupuncture and massage. If these treatments are used in combination, success rates may be well over 95% in pain relief and avoiding surgery.
Epidural injections are a pain relieving procedure. They’re not intended to fix any problem, but are designed to mask a patient’s pain. They can allow individuals to participate better in their physical therapy, play with their kids, get back to work, and reduce the need for narcotic medications for pain control.
They work well in both the neck, the thoracic spine, and the lumbar spine. They’re not meant as a treatment for simply neck pain or back pain itself. They are truly meant for pain that radiates out into the arms and legs from a pinched nerve. When a nerve is pinched from a herniated disc for instance, that in and of itself does not cause pain. What that does is spark up inflammation, which can then cause the radiating pain. It is the heavy anti-inflammatory nature of the steroid medication that is administered which relieves the pain by bathing the nerve roots with the cortisone.
Epidural injections are administered in an outpatient setting. Patients may receive IV sedation, but it is not absolutely necessary. They may just need some local numbing medicine where the needle is being placed into the skin. Currently almost all epidural injections involve steroid medication. In the future, most likely we will end up seeing some nonsteroidal medications and probably some stem cell injection materials as well.
There are 3 different types of epidural injections. These are intra-laminar epidural injections, which were the first type invented and involve placing the steroid medication just under the bone overlying the spinal canal. These work well but about a decade ago a new type of epidural was invented.
This option places the needle much closer to the area of nerve root compression and this is called a transforaminal epidural steroid injection. The foramen is where the nerve root leaves the spine and this injection goes out this area so it is called “transforaminal”. This is very common in the lumbar spine but not so common in the cervical spine. Up around the neck there is a potential for very serious competitions so most pain management doctors do not offer this kind of epidural injection there.
The third type of epidural injection is called a caudal epidural. A pain management doctor places the cortisone through the buttock region through an area called the sacral ala. The steroid medication is then injected along with some numbing medicine and it flows from the bottom of the spinal canal up and can reach a few levels for pain relief. This type of injection works better when a patient has multiple nerve roots compressed such as in spinal stenosis.
Overall, the complication rates from epidural steroid injections are very low. The good to excellent results hover between 75 to 90%. This is equivalent to surgical outcomes at the one-year point. A large study was published in the Journal of the American Medical Association showing that at the one-year point results were equivalent but the patients who had epidurals were able to avoid the risks of surgery.
Prior to undergoing spine surgery, individuals should look to see if epidural injections could help possibly avoid undergoing the knife.