Epidural steroid injection

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Illustration depicting epidural steroid injection

Epidural steroid injection (ESI) is a technique for relieving pain from spinal stenosis and spinal disc herniation. Using a needle, relatively small amounts of corticosteroids together with a local anesthetic are injected into the epidural space around the spinal cord and spinal nerves.[1] The anti-inflammatory effect of the corticosteroid is responsible for providing pain relief when radiculopathy exists. Most studies point out that pain relief from ESI's are short term at best and do not reduce the need for surgical intervention. The evidence is mixed concerning the safety and efficacy of ESI therapy since all steroid injectates, no matter the manufacturer, are not FDA approved for epidural administration.[2]


Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated.[3] Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.[3] Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.[3] While traditional techniques without image guidance, also known as "blind injections", can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.


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