If you or someone you know suffers from back pain, you probably understand how debilitating it can be. I wanted to share with you some details about a procedure we offer here at Precision Pain Care that can relieve that pain. It's called Lumbar Epidural Steroid Injection:

The spine can undergo many degenerative changes that result in painful inflammation of nerves, ligaments, and discs that may respond to epidural steroid injections. These conditions include disc herniations, spinal stenosis, and spondylosis (arthritis) of the spine. Epidural injections provide relief from pain when there is inflammation. Disc herniations may cause inflammation of the nerves due to noxious chemicals spilling out from the disc onto the nerve root, causing pain from the back or neck, down the arm or leg depending on the location of the disc herniation.

What is an epidural steroid injection? The epidural space is an area surrounding the spinal cord and spinal fluid where the nerves cross through in order to leave the spine.

An Epidural Steroid Injection (ESI) is an injection done in the epidural space surrounding the spinal cord of the back or the neck to treat a variety of painful conditions. It usually consists of long acting steroids (cortisone) that are solids suspended in liquids, in combination with local anesthetic. The steroids fall out of the solution after the injection and gradually dissolve, coating the nerves and relieving some of the inflammation. Epidural steroids will not "cure" spinal stenosis, nor will they dissolve or reduce disc herniation size (only surgery or the body's own enzymes can do this). They do provide moderate pain relief lasting typically a couple of weeks to several months, and permit greater function while the body is attempting to resorb and heal the disc herniation. Unlike disc herniations which tend to get better over time, spinal stenosis usually does not improve over time, and more frequent injections may be needed to treat this condition. There are 3 approaches to the epidural space of the low back: Caudal (from below), interlaminar (from the center of the back), and transforaminal (from the side of the back). The choice often depends on the level of the particular condition being treated.

• What to expect: You will need someone to drive you home, who can wait for you while you have your procedure.

• The patient lies face down on the X-ray table. Local anesthetic (Lidocaine) is used to numb the skin. Some patients request sedation, which requires an intravenous (IV) to give a small amount of short acting sedative (Versed). The majority of patients do not need sedation, however.

• How long will it last? Some patients get complete relief from a single injection. Others get partial relief that may improve with a series of injections. Most insurance companies will allow 3 injections in a six-month period, provided you get some relief from each injection. The effect of the steroid is generally from 3 weeks to 3 months.

• Risks: The most common risk is failure to relieve pain. This procedure helps some people, but it doesn't help everyone. There is always a risk of bleeding, infection, or nerve injury whenever a needle is placed into the body. There is a small risk of a spinal fluid leak, which can cause a headache. You should discuss specific concerns with your physician prior to having he procedure.

• Afterward: The local anesthetic will last 4-6 hours. You should expect some numbness along with your pain relief. After this wears off, your usual pain may return. Ice down the injection site, and take your usual pain medication. It will take several days for the full effect of the steroid to "kick in".

You can watch a video of how this procedure is performed on our website: www.precisionpaincare.com or call us at 615.223.6200.

Here's to your good health!

Sincerely,
Graf Hilgenhurst, MD