Epidural Steroid Injections and Corticosteroids
SpU: Please tell us about the epidural administration of corticosteroids to treat spine pain.
To treat lumbar or cervical radiculopathy, pain physicians prefer to administer corticosteroids directly to the spine. An epidural steroid injection is a common therapy used to deliver corticosteroid medication precisely where it is needed to help relieve symptoms from a herniated disc or spinal stenosis. These injections are performed under fluoroscopic guidance (low dose x-ray) by a highly trained and experienced physician.
Fluoroscopic view of the lumbar spine during an epidural injection.
SpU: What are the side effects of corticosteroids?
Weight gain is one of the most common side effects. Continuous (months to years) use of oral corticosteroids can cause abdominal stria (stretch marks), hypertension, moon faces, and osteoporosis. However, such serious side effects rarely occur in patients taking short-term doses of oral corticosteroids to treat lumbar or cervical pain.
SpU: Tell us more about the spinal epidural injection. What is your experience?
Spinal epidural injections to treat back and neck pain are a common nonoperative procedure. An epidural allows the physician to administer a more potent dose of corticosteroid medication by needle precisely to where it is needed. Longer acting corticosteroid preparations such as Depo-Medrol® are safely used to treat low back pain. Celestone® is a more soluble, less particulate corticosteroid medication used in cervical epidural injections.
In my practice, I perform lumbar (lumbosacral) and cervical epidural corticosteroid injections in a sterile procedure room using fluoroscopic guidance. Fluoroscopy is a low dose x-ray that allows the needle to be safely and precisely guided. The patient is given MAC anesthesia (Monitored Anesthesia Care; monitored sedation) by an anesthesiologist or registered nurse anesthetist. Patients are more comfortable during the procedure and they appreciate the added level of TLC. Medicare and most insurance carriers provide reimbursement for the procedure as described.
Another advantage to administering corticosteroids directly by epidural injection is there are fewer side effects than with prolonged oral administration of these drugs.