Steroid Injections

Overview

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 Injection (ESI)
    • Translaminar ESI
    • Transforaminal ESI
    • Caudal ESI
  • Facet Joint Injection
  • Nerve Root Block
  • Sacroiliac (SI) Joint Injection
  • Coccyx Injection

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.

Selected Bibliography

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Benzon HT: Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain 1986;24(3):277-95.

Botwin KP, Gruber RD, Bouchlas CG, et al: Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 2002;81(12):898-905.

Bowman SJ, Wedderburn L, Whaley A, et al: Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine 1993;18(10):1345-50.

Bush K, Hillier S: A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine 1991;16:572-5.

Buttermann GR: Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am 2004;86A(4):670-9.

Carette S, Leclaire R, Marcoux S, et al: Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336(23):1634-40.

Cuckler JM, Bernini PA, Wiesel SW, et al: The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg [Am] 1985;67(1):63-6.

Delport EG, Cucuzzella AR, Marley JK, et al: Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil 2004; 85(3): 479-84.

Depalma MJ, Bhargava A, Slipman CW: A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehabil 2005; 86(7): 1477-83.

Green PW, Burke AJ, Weiss CA, Langan P: The role of epidural cortisone injection in the treatment of diskogenic low back pain. Clin Orthop 1980;(153): 121-5.

Haselkorn JK, Rapp S, Ciol MA, et al: Epidural steroid injections and the management of sciatica: A meta-analysis. Arch Phys Med Rehabil 1995;76: 1037.

Kepes ER, Duncalf D: Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review. Pain 1985;22(1):33-47.

Lutz GE, Vad VB, Wisneski RJ: Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998;79(11):1362-6.

Riew KD, Yin Y, Gilula L, et al: The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 2000;82-A(11):1589-93.

Saal JA, Saal JS, Herzog RJ: The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine 1990;15(7):683-6.

Slipman CW, Gihool J, Chow DW, et al: Outcomes of therapeutic selective nerve root block for painful symptoms of epidural and/or intraneural fibrosis following diskectomy for a herniated disk. Arch Phys Med Rehabil 2001; 82:1325.

Stitz MY, Sommer HM: Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine 1999;24(13):1371-6.

Vad VB, Bhat AL, Lutz GE, Cammisa F: Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27(1):11-6.

Yates DW: A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica. Rheumatol Rehabil 1978;17(3):181-6.