Dr. Stefano Sinicropi, M.D.

An epidural steroid injection is a treatment technique that involves delivering concentrated medication to a specific area of the spine in hopes of quelling inflammation and pain at the source. Oftentimes the minimally invasive injection is paired with proactive physical treatments like exercise or physical therapy to restore strength and function at a time when inflammation is subdued. Used correctly and when paired with other interventions, these injections can be highly effective at helping you manage spinal discomfort, but not all injections are the same. In today’s blog, we look at the different types of lumbar epidural steroid injections for back pain.

Different Types Of Epidural Steroid Injections

Epidural steroid injections can be used to treat pain and inflammation caused by a number of different issues, including bulging and herniated discs, sciatica, spinal stenosis, bone spurs and more. Generally speaking, there are five main types of epidural steroid injections, and we take a closer look at each below.

• Caudal Epidural Steroid Injection – Caudal epidural steroid injections work by delivering medication into a patient’s epidural space through the sacral hiatus, located at the base of the spine. This method allows for broader coverage of lower spinal nerves, which makes it an effective option for patients dealing with lumbar radiculopathy or for those with lingering nerve pain following a surgical procedure. It is a great option when other injections are not feasible because of scar tissue formation or unique anatomical challenges. Given the positioning of the injection, there is minimal risk that the spinal cord is punctured, but it is less precise at targeting specific nerve roots compared to other injection approaches.
• Interlaminar Epidural Steroid Injection – With this injection, the needle is placed between the laminae of two adjacent vertebrae, typically in the lumbar or cervical region, allowing the medication to spread into the epidural space and affect multiple nerve roots. This is ideal for patients with radiating spinal discomfort that extends to the arms and legs, or when discomfort is not limited to a single nerve root. Again, it is better suited for more broader nerve coverage than specific nerve identification.
• Transforaminal Epidural Steroid Injection – Conversely, the transforaminal epidural steroid injection is a highly targeted approach that delivers medication through the neural foramen, a small opening where nerves exit the spinal column. This method allows for precise medication delivery at the site of nerve inflammation, making it an effective option for patients dealing with radicular pain or sciatica. Using contrast dye and fluoroscopy to guide the needle, the surgeon can get the needle in the precise location of a specific nerve root, maximizing the effects of the medication while minimizing exposure to surrounding tissue.
• Cervical Transforaminal Epidural Steroid Injection – This injection is a specialized version of the transforaminal injection that targets nerve roots in a person’s neck. It’s commonly used for patients with pinched nerves in the neck causing muscle weakness, numbness or symptoms that radiate to the arms. Given the proximity to vital structures in the neck region, exceptional precision is required. A skilled surgeon will use real-time image guidance to ensure the needle is placed into the neural foramen at the correct level. This injection can provide significant symptom relief for patients dealing with unresponsive discomfort in the neck, shoulders and arm.
• Thoracic Epidural Steroid Injection – Finally, a thoracic epidural steroid injection is an option when mid-back pain is unresponsive to other treatments. The injection is placed in the thoracic spinal region with the help of image guidance, as the spinal canal is narrower in this area. A thoracic epidural steroid injection is less common than injections in the upper and lower spine, as those areas are more mobile and conducive to nerve impingement, but it’s still an option for the right patient. It provides more targeted relief, but requires a high level of surgeon still to ensure the injection is administered precisely and without damaging crucial structures in the thoracic spine.

If you’re struggling to keep inflammation and discomfort at bay, talk with Dr. Sinicropi and the team at Midwest Spine & Brain Institute to see if an epidural steroid injection may be right for you. For more information, call our office today at (651) 430-3800.

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