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.
When non-surgical treatments for the SI joint fail, surgical options provide permanent stability and pain reduction. Our surgeons remain on the forefront of providing innovative evidence-based spine treatments. Our very own Dr. Christopher Good was the first surgeon in North America to perform robotic guidance sacroiliac fusion in June 2013. We are also very proud of Dr. Michael Hasz and his leading expertise in SI joint related pain. He has been performing SI fusions for nearly 20 years using various techniques, and in more recent years the iFuse Implant System. Dr. Hasz is a lead principal investigator in SIFI, an SI-BONE national prospective outcome study. Our collective expertise in SI fusion techniques and involvement in SIFI allows the Virginia Spine Institute to offer an array of treatment options for our patients suffering from sacroiliac related pain.
Pain after a corticosteroid injection is not the norm, but it’s not abnormal either. I can’t speak to your situation, but I can say that occasionally patients will have what’s called “post injection flare” where the pain is worse for 2-3 days after the injection. I would tell patients to put ice on the area and as long as it’s not red, swollen or with discharge at the injection site, sit on it for a couple days to see if it resolves. If it’s not any better after 2-3 days, then come into the office. And just so you know, it does NOT mean the injection did or did not work correctly, and it does not matter which technique was used to get the steroid into the knee joint.