Interlaminar Epidural Steroid Injection

The interlaminar epidural steroid injection is a procedure that is sometimes performed to help reduce inflammation in the spinal canal. The spinal canal is the space inside the spine where nerves travel. These nerves send signals to and from the brain, telling it how to control the body. It’s possible for the nerves inside this canal to become irritated or inflamed, either because of an accident or a medical condition.

When this happens, it’s possible for you to experience pain and loss of feeling in your limbs, as well as weakness in your muscles and stiffness in your joints. This can make it difficult or impossible to carry out daily tasks and may prevent you from working or enjoying everyday activities.

The interlaminar epidural steroid injection is designed to help control these symptoms by reducing inflammation and irritation around the nerves inside your spinal canal.

A cervical interlaminar epidural steroid injection is an injection of a steroid medication (e.g., Kenalog) and an anesthetic (e.g., Marcaine, or lidocaine) into the cervical epidural space.

The epidural space is the area between the lining (dura) surrounding the spinal cord and the lining surrounding the bony spinal canal. It is usually a small space, however in certain areas of the spine it becomes quite large to accommodate for nerve roots that exit from the spinal cord. The cervical epidural space refers to this area in the upper part of your neck, which houses these nerve roots. A steroid medication can be used as a treatment for pain because it has anti-inflammatory properties. An anesthetic can also be used to help decrease any inflammation around a nerve root and decrease pain in that particular area.

An interlaminar approach means that the doctor will access this epidural space through a space between two vertebrae in your neck called laminae, hence interlaminar epidural steroid injection.

The difference between an interlaminar and transforaminal approach is related to where the needle is placed within your cervical epidural space:

In an interlaminar approach, the physician will perform

Interlaminar epidural steroid injections place steroids into the epidural space around the spinal cord. They are performed to relieve pain in the neck or back (radicular pain). Steroids have anti-inflammatory properties and help to reduce swelling and inflammation.

In general, interlaminar epidural steroid injections are most helpful for back pain related to nerve root involvement or radiculopathy. They can also be helpful for spinal stenosis, but usually only if there is significant nerve root compression. In these cases, the steroid reduces inflammation of the inflamed nerve root(s), which results in relief of pain.

The injection is done while you are awake, but you will receive sedation medication through an intravenous line in your arm so that you may not remember much of the procedure. You will lie on your stomach on a special x-ray table with a pillow under your abdomen and your head turned to one side. The skin overlying the area to be injected is cleaned and sterilized using an iodine solution and alcohol. A local anesthetic (numbing medicine) will be injected into your skin and deeper tissues. This may sting briefly when it is injected, but it should feel numb after that.

Using fluoroscopic (live x-ray) guidance,

The interlaminar epidural steroid injection is a commonly used diagnostic and therapeutic treatment for low back and radicular pain.

The needle penetrates the sacral hiatus and injects a contrast material (i.e., water-soluble, nonionic iodinated contrast agent) into the epidural space, localizing the epidural space by means of an X-ray

The image guidance (i.e., fluoroscopy or CT scan) then confirms the correct positioning of the needle into the correct interspace, allowing for the injection of a combination of local anesthetic, such as bupivacaine or lidocaine, and corticosteroid, such as triamcinolone acetonide or methylprednisolone acetate.

An interlaminar epidural steroid injection is a type of injection used to treat lower back and leg pain caused by inflamed spinal nerves. The injection is done with the help of live X-ray imaging.[1]

The procedure is performed in the following manner:

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The patient is positioned prone and a sterile field is set up.

A fluoroscope (live X-ray machine) is used to identify the medial border of the superior facet joint, in the midline. A 22-gauge, 2.5 inch needle is placed using fluoroscopic guidance into the epidural space and contrast agent is injected. This confirms proper placement of the needle.[2]

A 20 mg dose of triamcinolone acetonide and 3 mL of 0.25% bupivacaine (Marcaine) are injected.[3]

Epidural steroid injections are a treatment option for nerve root pain, also known as radiculopathy. They have been used since 1952 and are considered an effective treatment for leg and arm pain caused by a compressed nerve root in the spine.

Epidural steroid injections are most commonly performed in the lumbar (low back) region of the spine but can also be performed in the cervical (neck) and thoracic (mid-back) regions to treat pain that radiates into the arms or legs.

How does an epidural steroid injection work?

The epidural space is a narrow channel between the outermost covering of the spinal cord and vertebrae located at the back of the spine. This is where spinal nerves exit from between each pair of vertebrae to travel down through spaces between muscles and bones to reach their destination in the lower back, buttocks, legs, feet and toes. Pain is often relieved when medication is injected into this area because it reduces inflammation around a nerve root.

INTRODUCTION

Epidural steroid injections (ESIs) are commonly used in the management of radicular lumbosacral pain. Despite their extensive use, controversy remains about the efficacy and safety of this procedure. The benefits appear short-lived, with a duration of benefit ranging from only a few weeks to several months. Complications are rare but include neurologic injury, infection, and spinal headache. Procedural risks may be minimized by careful patient selection and appropriate technique.

Indications

Painful degenerative disease of the spine

Radicular symptoms secondary to herniated nucleus pulposus (HNP) or spinal stenosis

Postlaminectomy syndrome

DISCUSSION

Pathophysiology

The pathophysiology of radiculopathy secondary to HNP is a combination of mechanical compression and chemical irritation. Mechanical compression is most likely due to displacement or extrusion of nuclear material from within the disc annulus fibrosus through an anatomic defect in the annulus (annular fissure, radial tear) and/or vertebral endplates. Chemical irritation arises from the presence of inflammatory mediators such as phospholipids, prostaglandins, bradykinin, histamine, lactic acid, collagenase

What is An Interlaminar Epidural Steroid Injection?

What is An Interlaminar Epidural Steroid Injection
What is An Interlaminar Epidural Steroid Injection

A interlaminar epidural steroid injection is an injection of steroids, such as cortisone, into the epidural space of your spine. Epidural steroid injections are used to treat back and leg pain caused by inflammation in the nerves.

The interlaminar area is in between the spinous processes, which are the bony projections that stick out from the back of your spine. The spinous processes are covered by the lamina, which is a part of the vertebrae that cover and protect your spinal canal.

The spinal cord and its nerve roots are within the spinal canal. Your spinal cord ends at about the T12 vertebrae. After this point, your nerve roots extend out of your spinal canal and branch into peripheral nerves, which carry signals to and from your brain and body. The peripheral nerves form pathways throughout your body.

If you have a disc herniation or spinal stenosis, it can put pressure on a nerve root. This can cause inflammation in one or more of these nerve roots. Epidural steroid injections can be used to treat inflammation in these nerve roots when other types of treatment have not worked well enough.

A interlaminar epidural steroid injection is a minimally invasive procedure used to treat back and leg pain. It is one of the most common procedures performed by doctors treating chronic pain. An interlaminar epidural steroid injection involves injecting steroids into your epidural space in your spine.

The epidural space is found between the bony part of your backbone, called the vertebrae, and a membrane that covers the vertebrae. The bones are separated by a gel-like material called nucleus pulposus. Nerves run through this area, so when this area becomes inflamed, it can lead to sharp back or leg pain.

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Steroid medications injected into the epidural space work by reducing inflammation around these nerves and alleviating pain. In some cases, an interlaminar epidural steroid injection may be combined with a local anesthetic to provide immediate pain relief.

An interlaminar epidural steroid injection is the most common epidural steroid injection. It involves injecting a medication into the epidural space over the affected nerve roots through a small tube called a catheter. An interlaminar epidural steroid injection is usually done in your doctor’s office with you lying face down on an X-ray table. Your doctor will clean your skin over the injection site with antiseptic and remove a small amount of bone (the lamina) to check that the needle is in the right location. This is called fluoroscopy.

Lumbar interlaminar epidural steroid injections have been used to treat low back pain and radiculopathy pain for more than 50 years. The idea behind the procedure is to inject a long-acting corticosteroid medication into the epidural space, around the spinal nerves in order to decrease inflammation and decrease pain. In the past, physicians used their best guess at where to inject the medication, but now with fluoroscopy, it is much easier to be sure that the medication is being placed where it needs to be.

The interlaminar approach involves injecting a needle into the epidural space from a more posterior direction than transforaminal injections. The needle is inserted between two of the vertebral lamina (the bony plates that make up part of your spine), in order to avoid damaging the spinal nerves.

Your doctor will use fluoroscopy (a type of live x-ray) to guide the needle into place, and then injects a special dye so that he or she can see exactly where the medicine is being delivered.

The epidural space is the area between the vertebrae, which are the bones that make up your spine. The area also includes a fat pad, blood vessels and nerves. An interlaminar epidural steroid injection uses a steroid medication to reduce inflammation and help relieve pain.

The injection is given in your lower back (lumbar region). It may be used to treat leg pain caused by herniated disks or spinal stenosis.

An interlaminar epidural steroid injection targets specific nerves in your spine that may help reduce pain.

Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain.

Epidural steroid injections (ESIs) may be performed using one of several techniques. The most common is the interlaminar technique, in which a needle is inserted through the back into the epidural space between the laminae of two vertebrae. Lateral recess or nerve root blocks may also be done by inserting the needle directly over the affected nerve root. Transforaminal epidurals fall somewhere in between these two techniques, because they are placed more laterally than an interlaminar injection but not as far as a lateral recess block.

The choice of technique often depends on the location and severity of your condition. In some cases, your doctor may feel that more than one approach is necessary to treat your symptoms effectively.

A spinal epidural is an injection of a steroid medicine into the epidural space in your back. Epidural injections are given to help relieve pain in the neck, arms, legs, or lower back. The epidural space is the area outside the protective covering of your spinal cord. The injection usually includes both a steroid and a numbing medicine called a local anesthetic.

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What is The Difference Between Transforaminal and interlaminar injections?

What is the difference between transforaminal and interlaminar injections
What is the difference between transforaminal and interlaminar injections

This is a tricky question that has a lot to do with how your spine is structured. In order to best give some background, let’s start by talking about the anatomy

of the spine and then talk about the two main types of injections: interlaminar and transforaminal.

The spine is made up of a series of bones stacked on top of each other and separated by discs. The discs serve as shock absorbers but also provide space for the spinal nerves to pass through. This space is known as the intervertebral foramen or neural foramen.

To understand both transforaminal and interlaminar injections it’s important to know where these nerves are located in relation to the bones. There are many small nerve roots that branch off from the spinal cord one at each level (or segment) in your spine. The nerve roots branch out into the arms, fingers, legs and toes, so these tiny nerves play a very important role!

Transforaminal injections are injections given directly into the foraminal space, which is one of the openings where exiting spinal nerve roots leave the spinal canal. The foramen is the hole where a spinal nerve exits from the spine. A transforaminal injection delivers a steroid medication into this opening to reduce inflammation and swelling of the nerve root, in order to provide pain relief.

Interlaminar injections are given directly into the epidural space. The epidural space is found in between the bony vertebra and ligament that covers it. An interlaminar injection is often used to relieve pain related to bulging or herniated discs.

The interlaminar space is located within the spinal canal and the transforaminal space is located outside of the spinal canal. Injections into the interlaminar space inject steroid into an area between the ligamentum flavum and the dura. Injections into the transforaminal space inject steroid into an area just outside of the spinal cord, in the foramen where a nerve root exits from the spine. Since there are no nerves located inside of the spinal canal, injections here can be performed without numbing a specific nerve.

Injections into in the foraminal space are more accurate because it is possible to inject directly into an area where a specific disc problem exists, such as a bulging disc that is compressing a nerve root. The disadvantage of this injection is that it requires numbing a specific nerve root with local anesthetic before injection and this can result in significant leg pain during injection. Treating a patient’s leg pain while they are receiving this treatment can be difficult unless they receive sedation.

The transforaminal approach targets a specific nerve root. Injections are made into the opening of the affected nerve in the spine. The interlaminar approach targets the general area between bones of the spine (vertebrae) called laminae. Injections are made into an opening just below the laminae.

Transforaminal Epidural Steroid Injections

Transforaminal epidural steroid injections deliver anti-inflammatory medicine, such as cortisone, directly to the area around a spinal nerve. The injection is placed just outside the protective covering (dura) of the spinal cord and nerve root.

Interlaminar Epidural Steroid Injections

Interlaminar epidural steroid injections deliver anti-inflammatory medicine, such as cortisone, directly to the area around a spinal nerve. The injection is placed within the epidural space in the center of your spine between the vertebrae.

A transforaminal epidural steroid injection is given from the side of the spine in the foraminal space, where the nerve exits the spinal canal.

An interlaminar epidural steroid injection is given directly into the center of the spinal canal.

A transforaminal epidural steroid injection is performed under X-ray guidance with a needle that is inserted into the area near a nerve root in the spine. The steroid medication is injected near the inflamed nerve root, which may help decrease swelling and inflammation of the nerve.

An interlaminar epidural steroid injection is also performed under X-ray guidance but is injected into the middle portion of the back where several nerve roots exit.