It is an effective method in spinal diseases that occur in the neck and waist region and cause nerve root compression. It is a very effective method in the treatment of diseases that cause low back and neck pain such as disc herniation (lumbar-neck hernia), slipped disc and narrow spinal canal. The aim here is to reduce inflammation and edema caused by compression and to dissolve adhesions. Epidural steroid injection is most effective in compression on nerve roots and disc herniations. 70-80% of patients with newly onset symptoms improve and do not require further treatment. In later cases, relief is provided for 2 months to 1.5 years or more in 50-70% of patients. ESE is more effective when performed within the first 6 months after the onset of the patient’s complaints. With epidural injection, a drug mixture containing a long-lasting depot steroid and a local anesthetic to provide relief in the early period is made around the damaged spinal nerve.
How is ESI Applied?
Intervention is performed by Algology specialists under continuous radiological imaging (with C-arm scopy). During the procedure, the vital functions of the patient are monitored by an anesthesiologist, and drugs are administered intravenously so that the patient does not feel pain. All procedures are performed under local anesthesia.
There are 3 techniques in ESE application:
Caudal Technique: It is a form of application by entering from the lowest part of the spine (sacral hiatus). In this application, a high volume of drug mixture must be applied in order for the drug to reach the upper parts of the spine.
Caudal Steroid Injection Scopy Image
Interlaminar technique: In this application, drug injection is made by entering the middle of the spine with a needle. A lower volume of drug is used compared to caudal injection. The risk of perforation of the dural sac is greater with this technique.
Interlaminar Steroid Injection Scopy Image
Transforaminal technique: The drug is administered around the affected nerve by entering a needle through the hole where the problematic spinal nerve emerges from the spine. It is an intervention for the targeted nerve for treatment. The least volume and highest concentration of drug is given in this technique.
Transforaminal Steroid Injection Scopy Image
Points to be Considered by the Patient Before ESE:
It is sufficient to fast for about 4 hours before epidural steroid injection. Medicines such as blood pressure pills and heart medications that are used continuously should be taken with little water. Blood thinners such as Aspirin® and Coraspin® should be discontinued 1 week in advance.
What to do after ESE
After the procedure, it is necessary to rest for 1-2 hours. After the injection, there may be pain in the lower back and temporary numbness and pain in the leg where the intervention was made. The complaint of pain that subsides after the intervention may start again within 4-6 hours. This is due to the fact that the effect of the local anesthetic has disappeared. The main effect of the long-acting steroid reaches the desired level within 48-72 hours and the pain complaint begins to decrease within 3-4 days.
For 2-3 days after the intervention, movements that will put excessive strain on the waist or neck should be avoided.
ESE Not Applicable Conditions
With infection in the intervention area,
Being pregnant or likely to be pregnant,
Serious bleeding, coagulation disorder
Patients who do not accept the intervention are not treated.
ESE Side Effects-What are the Risks?
Among the patients who received epidural steroid injection, there is a possibility of infection with a frequency of one in 40-60 thousand patients. For this reason, this possibility is minimized by performing the applications in absolute sterile conditions in the operating room.
Very rarely, temporary headache may occur. Nerve damage is also very rare. Especially since nerve damage is a serious side effect, the procedure must be performed under imaging with C-arm fluoroscopy in order to minimize the risk.
Depending on the steroid used, fluid retention in the body and deterioration in sugar regulation may be observed for 1-2 weeks in patients with diabetes.
