Epidural steroid injections can be performed in almost any area of the spine, from the neck (cervical) to the mid back (thoracic), all the way to the lower back (lumbar), and even as low as just above the tailbone (caudal). The specific location is chosen based on the area of injury or damage. Epidural injections can be used to treat many conditions including nerve compression, nerve injury, disc related pain, Complex Regional Pain Syndromes, and a variety of other indications. The specific type of epidural will be based on the underlying condition that is being treated and the patient’s injury. There are four basic types of epidural injections:
- A Midline or interlaminar approach in which the needle is inserted into the center of the spine through a small window between bones of adjacent spinal levels. This can be done in the neck, mid-back, or low back regions. This is typically used for central disc herniations or central canal stenosis and is also used when catheters or spinal cord stimulators are inserted into the epidural space.
- In a Transforaminal approach, a needle is inserted into an opening on the side of the spine, between the spinal bones, in the area where the nerve exits the spine. This bony opening between spinal levels is also called the foramen. In this case the injection is placed in close proximity to the nerve; injection in this location will typically cause reproduction of arm or leg symptoms. When the area of compression is within the foramen, a transforaminal approach tends to provide greater relief than an interlaminar approach.
- Caudal epidural injections are performed through a small opening in the spine called the sacral hiatus, which is located just above the tailbone at the base of the spine. Caudal injections can be used for the treatment of a variety of conditions including peripheral neuropathy and pathology or injury at the lowest lumbar levels. This approach is also commonly used with epidural lysis of adhesions procedures.
- Catheter guided – In this situation a needle is inserted via a mid-line or interlaminar approach into the epidural space. Through the needle, a catheter is guided into the area of damage. Once the catheter tip is properly positioned, and verified by contrast injection (to demonstrate that the medication will go to the intended location), medication is injected through the catheter. .