Obtaining a second opinion before proceeding with an epidural steroid injection can help to confirm that the appropriate site of nerve compression is being targeted.
In many instances, the spinal canal is a source of back and neck pain. The specific cause of this pain is often difficult to determine because significant degenerative abnormalities within the spinal canal can occur in asymptomatic people. Localized reactive inflammation may be the cause of spinal pain, rather than degenerative changes alone. In this regard, a chemical basis for lumbar radicular pain has been postulated. Steroids have a known antiinflammatory property and are thus considered to be reasonable agents to be injected into a “symptomatic” spinal canal. In spite of its theoretic potentials, the use of epidural steroids remains controversial. Nonetheless, efficiency with steroid injection has been shown to be greater when compared to that with saline or local anesthetic injection. At Connecticut Neck and Back Specialists, we insist that epidural steroid injections be administered under fluoroscopic guidance. This minimizes the risk of inaccurate installation of the medication. By targeting the epidural injection, either through an interlaminar approach or a far lateral transforaminal approach, we feel that the response to an epidural steroid injection can be diagnostic, as well as therapeutic. For this reason, obtaining a second opinion before proceeding with an epidural steroid injection can help to confirm that the appropriate site of nerve compression is being targeted. In other words, if a patient has a neurocompressive lesion at an L4-5 level and subsequently responds to an epidural steroid injection directed to this region, we feel that the patient’s response can serve as confirmation that the suspected lesion is indeed the source of the patient’s discomfort. The benefit of an epidural steroid injection usually occurs within several days of the injection.
Dural puncture with associated headache is the most common complication of epidural steroid injections. This occurs approximately 5% of the time and can be treated adequately with the administration of a blood patch. Infection is rare; however, intradural injection may lead to scarring and is to be avoided. In some cases, the use of epidural steroid injections may provide the definitive treatment. It is felt that in many instances, the use of a series of epidural steroid injections, up to 3 injections over a span of weeks to months, may provide longer lasting and more profound relief.