The epidural space lies outside the spinal cord between the vertebrae and the dura mater (a tough membrane which encloses the spinal cord and the cerebrospinal fluid). Via the epidural, the spinal nerves to the entire body can be accessed and treated with medications. The space is filled with loose fatty tissue and small blood vessels.
While oral pain medications and steroids are widely dispersed by the body’s circulation, epidural injections by contrast deliver medications directly to the pain generator. This targeted approach can often lessen or eliminate the side effects that many oral medications have. Another benefit is that an epidural steroid injection can help control localized inflammation while at the same time “flushing out” the area of inflammatory proteins and chemicals that may many times contribute to pain.
The three most common ways to access the epidural space for injection are:
- Translaminar – A translaminar injection accesses the epidural space between the lamina of the vertebrae in the back. The needle is inserted generally directly overlying the spine (a so-called posterior mid-line approach). The injection can be directed to one side of the epidural space or both.
- Transforaminal – A transforaminal injection allows access to the epidural space by passing through one of the bony openings in the side of the vertebra called a neuroforamen. Nerves from the spinal canal that exit through these openings. This approach is particularly useful if the nerve roots or discs are the likely pain generators.
- Caudal – A caudal injection is an epidural injection specifically placed via the sacrum (tail bone area). Pain generators located at the lower vertebral levels can be successfully treated utilizing this approach.
Your specialist will choose the epidural injection approach based on your particular and pain generator locations. Studies have effectively shown that fluoroscopy (real-time xray), used during all epidural injections at PainCare, allows for more accurate placement of the needle, more therapeutic efficiency and less risk.
Because pain relief from an epidural injection usually decreases after a time – lasting anywhere from several weeks to a year or more – it may be necessary to have a series of injections over a period of weeks or months or even regularly but infrequently scheduled injections. Despite even very temporary benefit epidural injections can be beneficial by providing the necessary pain relief for the patient to begin a rehabilitative/exercise program under the guidance of a physical therapist.
What types of pain can benefit from this procedure?
Epidural injections are used to treat nerve pain, swelling, and the inflammation that is so often associated with neurological conditions such as:
- Herniated disc disease
- Sciatica (lumbar radiculopathy)
- Spinal stenosis
- Degenerative disc disease
- Facet joints arthritis