WHAT IS IT?
A block that is performed under fluoroscopy to confirm a specific diagnosis and/or decrease pain and inflammation. Epidural steroid injections are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. Radicular pain is described as a sharp, lancinating, and radiating pain, often shooting from the low back down into the lower extremity in a radicular distribution. Radicular pain is the result of a nerve root lesion or inflammation. Epidural steroid injections have been recommended to deliver steroids in a more localized fashion to the area of affected nerve roots, thereby decreasing the systemic effect of the administered steroid. Studies have indicated that epidural steroid injection are most effective in the presence of acute nerve root inflammation. Clinical manifestations of nerve root inflammation include some or all of the following: radicular pain, dermatomal hypesthesia, weakness of muscle groups innervated by the involved nerve roots, diminished deep tendon reflexes, and positive straight leg-raising tests.

Epidural steroid injections can provide both diagnostic and therapeutic benefits. Diagnostically, epidural steroid injections may help identify the region and spinal column of potential pain generation through pain relief after local anesthetic injection to the site of presumed anatomic pathology. In addition, if the patient receives several weeks or more of pain relief, then it may be reasonable to assume that an element of inflammation was involved in his or her pathophysiology. This last element of diagnostic information is also the therapeutic element. Since prolonged pain relief is presumed to be due to a reduction in an inflammatory process, it is also reasonable to assume that during the prolonged pain relief, the afflicted nerve roots are also relatively protected from the deleterious effects of inflammation.

HOW IS IT DONE?
A local skin anesthetic is given. A spinal needle is then inserted into the epidural space of the lumbar or caudal spine. An anesthetic and steroid are injected into the epidural space.

HOW LONG DOES IT TAKE?
Thirty minutes plus approximately forty-five minutes recovery time.

EXPECTED RESULTS?
Relief of pain and increase in function if the medication reaches the inflamed area or source of pain.