Injections at Multiple Levels

Question: Multiple epidural steroid injections done at multiple levels?

I have tarlov cysts and my physician thinks they may be my remaining source of pain. I have them at T12, L5, and all the sacral levels. I had an epidural steroid injection at L1/L2 to see if it would affect the localized pain I was having around T12 and it did help, but had no effect on the pain lower down in my lumbar spine. My doctor is thinking that if the tarlov cysts are the pain source, and repeating the epidural but at L5/S1 to try to get closer to the lower cysts may be a good option.

I'm confused though because it seems like flooding the epidural space with cortisone regardless of where the needle is placed would spread the cortisone throughout the epidural space including the lower and higher levels. Is that incorrect? I know it's common for people to have multiple herniated discs, so is it normal to do the epidural at several levels to make sure all the discs and nerve roots get good steroid coverage?

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Doctor’s Response: Confirm diagnosis before using further injection treatments

Typically, the injection is done at one level and it can flow to the other levels. It does not have to be done at the exact level that of the disc herniation. The injection does not necessarily have to be done at the affected levels. A more pressing issue for you would be what your pain generator is. Tarlov cysts are a common MRI finding representing an outpouching of the dural sac. They are not thought to be a common cause of pain.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.

Written by Medical Reviewer