Injections of cortisone can be made directly into the area surrounding the nerve root affected by a damaged intervertebral disc. This is best done under fluoroscopic(x-ray) guidance, since this requires the use of a long needle which is placed deeply into the epidural space. Bruising and discomfort are common. Nevertheless, this procedure is generally used prior to surgery, since it is a less invasive alternative.

It is generally accepted that epidural steroids may, in some patients, produce short-term benefit, but multiple injections on different days are often necessary. A series of three injections is often given. Patients failing to respond to this multiple series are generally not subjected to additional attempts.

Risks of epidural steroid injections include infection, bleeding, nerve damage, headache, and risks due to the steroid medication (cortisone) used. The risks of cortisone are rarely seen with a single dose, but are more common if multiple doses are given. The most common adverse effects of cortisone are high blood sugar and insomnia. Epidural steroid injection under fluoroscopic guidance require x-rays, and should not be given in pregnancy.

TACT is an innovative new medical modality for patients with back pain associated with disc disease. Detailed information on TACT is available here.