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Epidural steroid injection (ESI) is a technique in which corticosteroids and a local anesthetic are injected into the epidural space around the spinal cord in an effort to improve spinal stenosis, spinal disc herniation, or both. It is of benefit with a rare rate of major side effects.
Facet joint injections came into use from 1963, when Hirsch injected a hypertonic solution of saline into facet joints. [3] He found that this solution relieved lower back pain in the sacroiliac and gluteal regions of the spine. In 1979 fluoroscopy was used for guidance of the needle into the facet joints with steroids and local anesthetics. [3]
In osteoarthritis, joint injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months. [5] Injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis, [6] [7] but did increase risk of further pain. [6]
Cortisone is a pregnene (21-carbon) steroid hormone.It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase isozyme 2 into the inactive metabolite cortisone, particularly in the kidneys.
The injection of steroids into the epidural space is sometimes used to treat nerve root pain, radicular pain and inflammation caused by conditions such as spinal disc herniation, degenerative disc disease, and spinal stenosis. [16] The risk of complications from steroid administration is low and complications are usually minor.
Intra-articular corticosteroid injections (IACI) are a second-line therapy to relieve joint pain resulting from rheumatoid arthritis. [19] It is most commonly injected into the joints of the knees and shoulders. [19] Although the injection is local, studies have shown systemic absorption as evidenced by beneficial effects on distant joints. [19]