Epidural Space

The epidural space is the space between the dura mater (the outer of three layers surrounding the spinal cord) and the vertebral wall, containing fat and small blood vessels. The epidural space is located just outside the dural sac which surrounds the nerve roots and is filled with cerebrospinal fluid. To treat back pain, doctors inject steroid medications into the epidural space along the segment of the spinal cord associated with the patient's back pain or sciatica. Epidural steroid injections are appropriate in conditions where there has been some degree of degenerative changes to the spine that are causing nerve root compression, and radiating nerve pain in that section of the spine and possibly down one of the legs. The steroid medication delivered to the site of pain may have the immediate effect of pain relief that may last between hours to possibly even several months. One of the most minimally invasive procedures associated with the epidural space in the spine are epidural steroid injections.

Epidural Steroid Injections. When degenerative changes to the intervertebral discs, facet joints, or other musculoskeletal changes to the spine cause nerve root compression, the result may be disabling pain or a loss of sensation in one or more of the legs. The nerve root compression may be a result of lumbar spinal stenosis, degenerative disc disease, or bulging disc, while the results may be a swelling of the spinal joints and swelling around the nerve root, affecting it's ability to receive and transmit singles. To reduce the swelling around the nerve root, doctors may deliver a potent anti-inflammatory medication to the area with steroid medication into the epidural space immediately around the area of damage. The results of this injection of medicine may be immediately relief that lasts for a few to several months. While this medicine will not act to cure the structural changes that caused the inflammation, it may be successful at giving the patient a few months of increased activity and comfort levels so that they can continue with an exercise program designed to strengthen the muscles around the spine, so that they are able to manage their back problem without medication in the future.

Though epidural steroid injections are listed as a minimally invasive procedure, it is still technically a surgical procedure. As with any surgical procedure, there are some risks involved, though those risks are very rare. Possible adverse reactions associated with these procedures include loss of muscle power/weakness in the muscles, nerve damage and dural puncture, spinal headache, bleeding, and infection.

Why they're used. Epidural steroid injections are used to treat back problems such as sciatica that involve nerve root compression of one or more of the lumbar nerve roots. Sciatica involves compression of the sciatic nerve, which runs from the bottom of the spine (it begins near the middle of the sacrum), behind the thigh and to the knee before dividing into smaller nerves.

The day of the procedure. The procedure is relatively quick (taking between 15-25 minutes), and may be performed by a doctor at a hospital or outpatient clinic. The procedure will be performed in two parts. In the first part of the procedure, a local anesthetic will be introduced into the area to numb the area and make the insertion of the needle delivering the steroid medication less painful. Next, the needle will be guided into the epidural space and the steroid solution will be injected.