Corticosteroids are used to control inflammation in arthritis and other inflammatory conditions. Corticosteroids can be injected directly into inflamed tissues, or they can be delivered to the whole body via oral preparations, intravenous injections, or intramuscular injections. Steroid injections may provide significant relief to patients with arthritis or musculoskeletal conditions. For patients with rheumatoid arthritis , the injections are typically offered when only one or two joints display active synovitis . The goal of treatment is to quell symptoms of a flare or to enable slower-acting drugs, such as methotrexate or Plaquenil , time to work. For example, in early rheumatoid arthritis, study results revealed that a combination of DMARDs and intra-articular steroids is significantly better than DMARDs alone.
Cervical Epidural Steroid Injections involve injecting a steroid into the epidural space of the cervical spinal canal where irritated nerve roots are located. The injected medications include both a long-lasting steroid and a local anesthetic (Lidocaine, Bupivacaine).
The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain-spasm cycle and nociceptor transmission (Boswell 2007). The medicines spread to the most painful levels of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.
Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.