An epidural steroid injection places this powerful anti-inflammatory medication directly around the spinal nerves. Traditionally epidural injections were administered without any special equipment, by inserting the needle by feel in the area around the spinal nerves. More recently epidural injections have been administered with the aid of imaging tools to allow your physician to see the needle going to the proper location. Either real-time x-ray called fluoroscopy, or CT scan can be used to 'watch' the needle deliver the medication to the proper location.
Epidural injections are often used to treat radicular pain, also called sciatica , which is pain that radiates from the site of a pinched nerve in the low back to the area of the body aligned with that nerve, such as the back of the leg or into the foot. Inflammatory chemicals (. substance P, PLA2, arachidonic acid, TNF-α, IL-1, and prostaglandin E2) and immunologic mediators can generate pain and are associated with common back problems such as lumbar disc herniation or facet joint arthritis . These conditions, as well as many others, provoke inflammation that in turn can cause significant nerve root irritation and swelling.
Usually the effects of steroids become apparent over two weeks. If the scar tissue softens and flattens with the steroid injection, I will typically schedule the next injection in 2-4 weeks. In some areas, I’m worried the scar tissue will flatten out too much and become an indentation, so I will dilute the steroid injection to a weaker dose to prevent the scar from flattening too much and causing a dent. For some raised scars, the diluted steroid injection to not strong enough, so I will increase the concentration of the steroid injection for the next session. If the diluted steroid resulted in a flattening of the scar without overdoing it, I will simply repeat the same dilution and amount as I did the first injection.