Epidural injections have been used to treat low-back and radicular pain for the past 100 years; these injections have included corticosteroids for the past 50 years. As the technique has evolved and become more widespread, epidural steroid injections have become an important part of the armamentarium in treating low-back pain, sciatica, and, to a lesser degree, neck pain.
The solution to back pain continues to vex physicians and their patients. Most patients with acute disc herniations will improve without surgery (1); however, even those who recover without invasive therapy often suffer pain and disability in the meantime. This may lead to lost wages and diminished productivity. Although epidural steroid injections are not a cure for the root cause of pain, they may reduce or eliminate the pain in the short and intermediate term (2), allowing rehabilitation to proceed and a speedier return to normal activities (3). Even though occasional patients experience permanent, complete relief from epidural steroid injections, one cannot advise patients that they will achieve lasting relief purely from the injection. The goal is to improve symptoms, which will allow a more normal lifestyle and facilitate other modes of therapy (4).
This chapter reviews the relevant anatomy for epidural injections, history of the technique, medications, practical steps, and other relevant information of epidural injections. A variety of routes will be discussed.
The epidural space exists from the skull base through the sacrum.