Epidural Steroid Injection, Lumbar Spine

KEY FACTS

Terminology

• Corticosteroid/anesthetic injection into lumbar epidural space via interlaminar, transforaminal, or caudal approach

Preprocedure

• Indications

  • Lumbar radiculopathy

  • Residual pain following vertebroplasty/kyphoplasty

• Things to check

  • Prior imaging: Adequate epidural space (especially important in postoperative back!)

• Avoid interlaminar approach in patient with severe canal stenosis without identifiable epidural space on preprocedure imaging

• Literature supports use of nonparticulate steroid (dexamethasone) to minimize possibility of small vessel vascular embolization

Procedure

• Interlaminar epidural steroid injection (ESI)

  • Target superior lamina near midline

• Transforaminal ESI

  • Target superomedial neural foramen

• Caudal ESI

  • Target sacral hiatus at midline, and consider catheter placement in patients requiring higher lumbar level injections

Post Procedure

• Expectations

  • Reproduction of pain with needle placement/injection

  • Significant improvement in pain after injection

Outcomes

• Most feared complications

  • Intravascular injection/spinal cord ischemia

  • Spinal cord puncture

TERMINOLOGY