USC Center for Spinal Surgery
Steroid injections are a commonly prescribed treatment for numerous orthopaedic ailments, including many spinal disorders. When oral medications and/or physical therapy fail to improve a patient's spinal condition and/or a patient has severe incapacitating pain, spinal injections can be a very effective treatment option. Depending on the type and location of the spinal problem, a small dose of steroid medicine can be injected, under x-ray guidance, into the right spot, often alleviating the pain and inflammation immediately.
There are different types of spinal injections. The most commonly prescribed spinal injection is an epidural steroid injection (ESI). Other types of steroid injections include facet joint injections, nerve root blocks, sacroiliac joint injections, and coccyx injections. A different type of steroid injection may be prescribed, depending on the specific spinal disorder being treated.
Types of steroid injections of the spine
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.
Facet injections and/nerve root blocks are prescribed for patients with severe facet joint arthritis or nerve inflammation, and can be performed at the same time with an ESI if necessary. Sacroiliac and coccyx injections are administered for patients with sacroilitis or coccydynia.
The results of steroid injections in the treatment of cervical, thoracic, lumbar, and sacrococcygeal spinal problems are generally excellent. 70-90% of patients demonstrate improvement. A medical study by Riew et al. showed that 77% of patients considered to be candidates for spinal surgery improved enough with steroid injections and did not require surgery.
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