Epidural steroid injections and selective nerve root blocks

Epidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. When isolated lumbar nerve root irritation is more clearly suspected, transforaminal nerve root blocks can provide useful diagnostic information as well as deliver more specifically targeted steroid treatment. Sustained pain relief can be achieved in a substantial number of patients with both types of procedure. Here we review the clinical indications and technical approach to these fundamental image-guided procedures. Fluoroscopy can be the routine approach to all injections. Computed tomography or computed tomographic fluoroscopy can be used as the primary approach in lumbar epidural or nerve root injections or be used as an alternative technique in unique cases. While the basic technical approach to epidural steroid administration in the cervical, thoracic, and lumbar regions is similar, each region has unique issues that must be addressed.