Epidural injections for relief of chronic back and neck pain has been performed by physicians for generations.It has evolved the way so many procedures have to become more specific and hence diagnostic as well as still serving its therapeutic value to the patient.Current thinking dictates that epidural injections should be performed using fluoroscopic guidance to ensure correct needle placement during the procedure.
Epidural injections can be performed essentially anywhere along the spine, including cervical, thoracic, lumbar, sacral, and caudal, depending upon where the pathology dictates.
There are essentially 2 types of injections - interlaminar, and transforaminal. Interlaminar injections are the “old style” injections given directly midline and between the spinous processes. They are more effective with posterior pathology with the epidural space and with bilateral spinal pain syptomatology. Transforaminal injections (formerly known as selective nerve root blocks) are far more specific, and are targeting a single individual nerve root as it exits the spinal canal.
The decision of when to use which technique is a clinical judgement on the part of the physician when taking into account the patient’s pain and neurologic complaints and symptoms, physical examination findings, imaging studies, such as MRI or CT scan, and historically if any of these techniques have been tried already and the results they have had in controlling the patient’s pain.