Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.
Discography, an invasive procedure, is performed using fluoroscopy (similar to x-ray, except in real time). To help you relax during the procedure, mild sedation may be administered. However, we cannot completely sedate, or put you to sleep, as you need to be alert enough to report what you feel to our team during the injection. An antibiotic may also be given intravenously before and after. You may be positioned, with pillows for support and comfort, on your side, or in another position. The injection sites are cleansed using an antiseptic and an anesthetic numbs the skin.