Epidural Steroid Injection Procedures are a common and minimally invasive procedure to treat inflammation present inside the spinal canal. This inflammation can occur in the spinal nerve, due to tissues next to the nerve (disc, facet joints, scar tissue, bone spurs, bone material) pressing or rubbing against it. The beginning of the nerve (nerve root) is most often irritated by an displaced intervertebral disc, bulged, herniated (protrusion, extrusion, sequestration) or a diseased disc (torn, fissured, collapsed, degenerated), directly.
Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.
A dural puncture, or "wet tap," is perhaps the most common complication from an ESI. This complication only occurs in to 5 percent of all injections. The result of a dural puncture is usually a spinal headache and nausea. A spinal headache occurs when the puncture in the spinal sac fails to seal itself off. This allows the spinal fluid to continue to leak out and lowers the spinal fluid pressure in the brain. When sitting or standing, the headache and nausea are much worse because the spinal fluid pressure is lower at the top (near your head) than at the bottom of the spine. The headache usually goes away when you lie down with your feet higher than your head.