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Epidural steroid injection (ESI) is a technique in which corticosteroids and a local anesthetic are injected into the epidural space around the spinal cord in an effort to improve spinal stenosis, spinal disc herniation, or both. It is of benefit with a rare rate of major side effects.^[1][2]

Medical uses

Epidural steroid injection for sciatica and spinal stenosis is of unclear effect.^[1] The evidence to support use in the cervical spine is not very good.^[3] When medical imaging is not used to determine the proper spot for injection, ESI benefits appear to be of short-term benefit when used in sciatica.^[4] It is unclear if ESI is useful for chronic pain after spinal surgery.^[5]

Side effects

Major side effects are rare.^[2] These include loss of vision, stroke, paralysis, or death when the corticosteroids are infected, as in a 2012 meningitis outbreak.^[2][6] Another study found an increased odds of developing epidural lipomatosis, independent of body mass index (BMI) or other factors.^[7]

Technique

Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated.^[8] Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.^[8] Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.^[8] While traditional techniques without image guidance, also known as blind injections, can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.^{[citation needed]}

References