Many clients who have suffered back injuries in a car accident are recommended to have a steroid block injuection in their back to relieve the pain. Sometimes there are a series of shots.
Epidural steroid injections (ESIs) are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. Radicular pain is described as a sharp, lancinating, and radiating pain, often shooting from the low back down into the lower extremity in a radicular distribution. Radicular pain is the result of a nerve root lesion or inflammation. ESIs have been recommended to deliver steroids in a more localized fashion to the area of affected nerve roots, thereby decreasing the systemic effect of the administered steroid. Studies have indicated that ESIs are most effective in the presence of acute nerve root inflammation.
Several indications for ESIs have been reported in the literature. Although the primary indication is radicular pain associated with a herniated nucleus pulposus, a variety of indications have been reported. Lumbar ESIs may be indicated for lumbar radicular pain associated with any of the following conditions: Lumbosacral disk herniation, spinal stenosis with radicular pain (central canal stenosis, foraminal and lateral recess stenosis), compression fracture of lumbar spine with radicular pain, and facet or nerve root cyst with radicular pain. Cervical ESIs have been used to treat the following conditions: Pain associated with acute disk herniation and radiculopathy, postlaminectomy cervical pain, cervical strain syndromes with associated myofascial pain, and postherpetic neuralgia. Thoracic ESIs have been reported within the medical literature as treatment pain associated with the following conditions: Acute thoracic disk pathology, thoracic radicular pain secondary to disk herniations, postherpetic neuralgia, trauma, diabetic neuropathy, degenerative scoliosis, idiopathic thoracic neuralgia, and thoracic compression fracture.
Absolute contraindications for ESIs include the following: Systemic infection or local infection at the site of planned injection, Bleeding disorder or fully anticoagulated (eg, on a fully ‘therapeutic’ dose of coumadin, heparin), History of significant allergic reactions to injected solutions (eg, contrast, anesthetic, corticosteroid), Central canal stenosis at the site of planned injection (it is acceptable to enter through the adjacent foramen or via an interlaminar approach 2 segments below).
In addition, fluoroscopy should not be used in epidural injections for women who are pregnant, to avoid exposing the fetus to the fluoroscopy. Use caution when performing injections in patients with poorly controlled diabetes since the corticosteroid injection may transiently increase the blood glucose levels. Use caution when performing injections in individuals who have a history of congestive heart failure because of the potential for steroid-induced fluid retention.
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