Understanding Epidural Steroid Injection for Herniated Disc, Pinched Nerves, or Spinal Stenosis

Doctor feeling area of pinched nerves in patient’s back

Epidural steroid injection is a common safe, simple, non-surgical procedure that is used as part of a treatment for neck pain with radiating arm pain or lower back pain with radiating leg pain. The goal of epidural injection is to reduce inflammation around the affected nerve or spinal cord. By eliminating the inflammation of the nerves, the pain management doctor will resolve the associated pain.

Causes of Neck and Back Pain

The neck region is referred to as the cervical region. Below the cervical region is the thorax. This region of the spine is referred to as the thoracic region. Next comes the abdominal region in which the spine is called the lumbar spine. The lowest part of the spine enters the pelvic region and is called the sacral spine. Between each of the 33 vertebral spine bones, the intervertebral discs which are cushions that act as shock absorbents made of cartilage, collagen, and water are what can herniate. These cartilaginous discs normally allow for movement of the spine and the protection of the nerves which come out of the spinal cord.

The most common cause of neck pain or back pain are spasms of the neck or back muscles. These will either resolve on their own, with a heating pad, or with physical therapy.Some may require a trigger point injection to release the spasm. Physical therapy can also be of great help to prevent the reoccurrence of neck pain or back pain.

The second most common cause of neck pain or back pain that may require an epidural injection is a disc herniation. Also known as a slipped disc, or bulging disc, they can cause pain to travel into the arms or legs, as well as down into the hands or feet. Pain in the neck or back that then travels along the course of the pinched nerves through to the arms or legs is called radicular (nerve root) pain. Pain originating from the spine can also be caused by a narrowing of the spinal canal called spinal stenosis. Each of these conditions can cause severe pain in the neck or back.

 A herniated disc is when a part of the spine suddenly bulges out or is torn open, and the content presses on a surrounding nerve or the spinal cord itself. The nerve or spinal cord becomes irritated by the pressure causing radiating pain depending on the level of the herniated disc. If there is a neck herniation, pain in the neck will travel down the arm. If it is a lower back herniation, the pain will travel from the lower back through the buttocks, and/or into the leg and possibly the foot.

The most frequent spine level of herniation is at the lumbosacral disc. The most common level is between the fourth and fifth lumbar vertebral body (L4-L5) or the fifth lumbar and first sacral body (L5-S1). Lumbosacral disk herniation and its associated radicular pain are called sciatica. It also can be treated with an epidural steroid injection.

Cervical disc herniation is most common between the fifth and sixth cervical vertebral body (C5-C6) or between the sixth and seventh vertebral body (C6-C7). In many cases, a cervical disc herniation is associated with an acute injury such as an automobile accident or sports injury. Most can be resolved with physical therapy and maybe an epidural steroid injection. The annual incidence is 85 cases per 100,000 population. If a neck herniation is severe enough, the patient can lose both arm and leg strength and function. In this situation, an epidural would be bypassed, and the patient would be considered for a herniated discectomy surgery.

Interestingly, only 10-25% of patients with a herniated disc develop symptoms that persist for more than six weeks, and which require additional intervention such as epidural steroid injection or surgery.

What Is an Epidural Steroid Injection?

An epidural steroid injection is a same-day procedure that takes merely 10 minutes to complete. The CNSO board-certified pain management specialist doctor will numb the surrounding area of the neck or back at the level of the pinched nerve or spine. The doctor will then inject steroid medication into the space (known as the epidural space) near the irritated nerve.

It is better to control pain early in the course of a herniated disc or pinched nerve in order to minimize inflammation and prevent permanent nerve damage. An epidural steroid injection might be the best solution for neck or back pain. It should be considered if the radicular pain has not resolved after 6 weeks of physical therapy or physical therapy is not improving the pain. There are circumstances when physical therapy can be bypassed due to pain intolerance or the severity of the herniation.

To provide an accurate diagnosis and develop a comprehensive rehabilitation program for conditions that cause back and radicular pain that may require an epidural steroid injection (ESI), a team of specialists is needed. The Centers for Neurosurgery, Spine, and Orthopedics is comprised of neurosurgeons, orthopedic spine surgeons, pain management specialists, and physical therapists that will together, perform a complete medical history and physical examination, including a neurologic evaluation, to identify the nature and the location from which the pain is emanating. The causes can range from spinal stenosis, pinched nerve, facet, or nerve root cyst to slipped or herniated disc.

NJ’s Only Facility for Herniated Disc Pain Treatment

The dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how back problems can impact daily life. By working with recognized board-certified neurosurgeons, orthopedic spine surgeons, pain management specialists, physiatrists, rehabilitation specialists, and certified physical therapists, patients will receive comprehensive and coordinated care, so they can resume a healthy lifestyle free from disabling pain.

CNSO offers multiple convenient locations spanning from Morris County to Hudson County and including nearby towns of Morristown, Jersey City, Hoboken, and Paramus, NJ. Northern NJ patients can learn more about the use of epidural steroid injection and the causes of neck and back pain that will resolve with an epidural injection or other types of treatment by contacting the doctors at CNSO today.

Centers for Neurosurgery Spine & Orthopedics
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