What is an ESI (Epidural Steroid Injection)?
An ESI consists of an anesthetic numbing agent (bupivacaine, lidocaine) and a long-lasting corticosteroid (betamethasone, triamcinalone). The drugs are subsequently delivered into the patient’s epidural area of their spine; the space between the bony vertebrae and the spinal cord’s dura (protective covering). This specific area is full of tiny blood vessels along with fat.
Corticosteroid injections work to diminish acute inflammation and are quite effective when directly delivered into the sensitive and painful area. Sadly, the ESI doesn’t actually make a herniated disc any smaller in size, but is only effective on the spinal nerves. The relief from pain can last for days, sometimes years, enabling you to improve the overall condition of your spinal cord in addition to performing physical therapy and a daily exercise program.
Who is a good candidate for ESI?
Patients who suffer with ongoing pain in their neck, lower back, arm, or leg (sciatica) may greatly benefit from receiving ESI, especially those with any of the following conditions:
The gel-like substance inside the disc can either rupture or bulge through a vulnerable weak area in the nearby wall, or annulus. Swelling, pain, and irritation occur when the substance oozes out and makes contact with the patient’s spinal nerve.
Sciatica refers to an intense pain that runs along the sciatic nerve located in the buttocks and courses down the leg. It’s typically due to the compression of the 1st sacral or 5th lumbar spinal nerve.
If the nerve root canal and spinal canal start to narrow, it can cause significant leg and back pain, particularly when walking.
An aging or breakdown of the intervertebral disc that causes the disc space to collapse, growth of bone spurs, and tears in the annulus.
A fracture or weakness between the lower and upper parts of a vertebra. Essentially, if the vertebra inadvertently slips forward, it can painfully compress the nerve roots.
Why are ESIs limited?
ESIs are generally limited to only a couple a year (more or less depending on the specific situation in combination with the advice of the doctor) since there’s a possibility these kinds of drugs may weaken your nearby muscles and spinal bones. This is a potential side effect from the steroids and not from the actual needle itself. The more ESIs you receive, the greater the chance that these side effects will occur. In general though, a lumbar epidural steroid injection is considered a safe and effective practice.
ESIs contain drugs that imitate the effects of two key hormones: hydrocortisone and cortisone. When injected close to the irritated nerves in the spine, the drugs work to temporarily diminish inflammation as well as help relieve pain. However, steroid injections also disturb the natural hormone balance within the body. Furthermore, deferring repeat injections will enable the body to return to its normal and natural balance.
It’s wise to carefully consider the possible risks as well as benefits regarding long-term ESIs. If you’re experiencing a great deal of pain between ESIs, it may benefit you to talk to your doctor about other kinds of treatment plans for chronic back pain.
How often can ESIs be performed?
No definitive research exists to dictate how often a patient should actually receive ESIs for leg pain or lower back pain. In some cases, some patients receive as many as three ESIs within a 6-month period.
V. K. Puppala, M.D. is located in Villa Rica, GA and serves patients throughout the Metro Atlanta area. He is extraordinarily skilled in treating all his patients with empathy, respect, and compassion along with providing outstanding pain relief through effective pain medication management, interventional techniques, and practical restoration. Contact the office of Dr. Puppala today to schedule a visit, by calling 770-627-7246 or 770-MAP-PAIN.