Back pain affects nearly everyone at some point in their adult life. Often times the exact cause of pain is not readily apparent, as there are many factors which may contribute to a patient’s
back pain, including disc disease, referred pain, as well as psychological factors. This can make the exact site and level responsible for the back pain more challenging to localize and diagnose. Unfortunately, while imaging studies (X-RAYs, MRI and CT scans) are helpful in screening the spine for potential causes of back pain, sometimes they don’t demonstrate an exact cause for a patient’s
pain. Back pain may arise from any anatomic structure within or around the spine which has nerve endings and is capable of transmitting pain. These structures include discs, facet joints, muscle, nerves, ligaments and dura (the membrane lining of spinal canal). All of these structures are either directly touching or in close proximity to the epidural space
. Pain may be either within the spine itself (‘axial’), or radiating from the spine (‘radicular’). Both of these types of pain are ideally alleviated with the ESI. The Epidural Injection (ESI)
is a procedure that anesthetizes the space around the spinal sac (dural sac). This procedure may be performed at any level of the spine, although is most commonly performed in the lumbar spine or cervical spine. As opposed to a selective nerve root block, or a facet injection, which target a specific nerve or joint on one side of the spine, the ESI treats several consecutive levels on both sides of the spine. The ESI procedure delivers a low volume of concentrated medication directly into a portion of the epidural
space. The ESI typically covers the epidural
space of about 3 vertebral body levels.
What is the epidural space?
The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural
space. Nerves travel through the epidural
space to your back and into your legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.
What is an epidural and why is it helpful?
An epidural injection
places anti-inflammatory medicine into the epidural space
to decrease inflammation of the nerve roots, hopefully reducing the pain in your back or legs. The epidural
injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing. Depending on the location of your pain, the epidural
steroid injection can be given in the neck (cervical), middle back (thoracic) or lower back (lumbar).