Epidural Steroid Injections

The epidural space is a potential space that is continuous with nerve roots and the thecal sac that contains nerves, when there is a herniated disk the disk irritates nerve roots and the result is pain. The epidural steroid injection applies steroid liquid in close proximity to the affected nerve root. The evolution of the technique now includes using fluoroscopy to demonstrate with x-ray pictures exactly where the steroid is going. There are 3 different approaches to the epidural space,the translaminar which is the most conventional places the needle between the spinous processes,the transforaminal the needle over the nerve root in an oblique plane and the caudal which goes very inferior in an area of the sacrum called the sacral cornu. Each approach has its advantages and disadvantages but allow more direct application of liquid to the affected level. The rationale for the treatment is to deliver steroid to the area to decrease inflammation to the affected nerve root. Most researchers now believe that the pain patients feel after disk herniation is called by an inflammatory reaction when the nucleus pulposus ruptures into nerve roots.