Epidural Injections

Lumbar Epidural Steroid Injections

Epidural steroids (with or without local anesthetics) are frequently given in our Pain Clinic. These injections are given in a series of three separated by at least two week intervals (usually more). On each return visit you will be re-evaluated to see if the next injection is indicated. We use this for treatment of low back pain due to nerve root irritation (radiculopathy). Irritation of the nerves can be from a herniated disc or scarring after back surgery. This irritation can cause inflammation and swelling of the nerve roots. The steroids we inject can help to decrease this. The local anesthetic initially resolves some of the pain before the steroids take effect – about two days. Your chronic low back pain may also have other components that are giving you pain. These may include guarding of muscles, depression, anxiety, etc. It will usually take a long time to get chronic pain and a long time to relieve it. Our goal is to bring you back to a useful and relatively pain-free lifestyle. Possible Side Effects: Bleeding or bruising, infection, lack of pain relief, temporary worsening of pain, headache. You may have additional risks if you are a diabetic or on a blood thinner agent. Tell your doctor if you have these or any other major medical problems. Before you show up: No eating or drinking (except for your usual medications and a sip of water) from 12 o’clock midnight until after the injection. Bring someone to drive you home. We will not perform the injection if you have not done these things. It is for your own safety.

The Injection: You will be asked to sign a consent and we will answer any last minute questions at this time. You may get into a gown and sit or lie on a table. You will feel cold solution on your back followed by a small needle stick, which may burn slightly. This is local anesthetic. This is followed by the injection, which may take several minutes to place. If you feel pain shooting down a leg tell the doctor. He will need to reposition the injection. The doctor will tell you what is going on step by step. If doesn’t, ask him! After the injection you might get immediate pain relief, or it may take several days. If local anesthetic is used your legs may be weak for several hours, so do not drive! You may want to use a heating pad or hot water bottle that night if your back is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one. Thank you for your help in following these guidelines to make this a safe and helpful experience for you.

Cervical Epidural Steroids Injections

Please see Lumbar Epidural Steroids Injections for introduction and possible side effects and things to do before you show up.

The Injection: Depending on your pain physician, you will either be asked to lie in the face down position on the operating room table or to sit in a chair with your head flexed against your chest and your forehead resting on a table. In either case, fluoroscopic guidance will be used to find the region of your neck that is targeted for pain relief. A solution of local anesthetic will be placed in between the bones of the neck with a very small needle to numb this region. This will be followed with a special needle used to do epidural steroid injections in conjunction with fluoroscopic guidance to find the epidural space in the neck. At this time a special radiopaque dye used for x-rays may or may not be used to confirm needle placement. This will be followed with a solution containing steroids, which is placed into the epidural space. The procedure takes approximately 5 minutes. You will be in the clinic for approximately 30 to 45 minutes for recovery. Complications: After the injection you may get immediate pain relief or it may take several days. If local anesthetics are used your arms may be weak for several hours so do not drive. You may want to use a heating pad or hot water bottle that night if your neck is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one.

Caudal Epidural Steroid Injections

These are injections that are usually reserved for patients who have had low back surgery in the past and who now have repeat pain in the same or different nerve root distribution. Once again, please see the Lumbar Epidural Steroid Injections section for general information including side effects and things to do before you show up. The Injection: The patient is brought into the operating room in the face down position with a pillow under the abdomen and the C-arm is brought into place to be used for fluoroscopic guidance. A generous amount of local anesthetic is placed at the bottom of the spine, just above the buttocks. This is followed with an epidural needle into the caudal epidural space. Once again, this may or may not be confirmed with x-ray dye. Then a mixture of local anesthetic with steroid or normal saline with steroid is placed, depending upon the patient. After the injection the patient may get immediate pain relief or it may take several days. Complications: If local anesthetic is used your legs may be weak for several hours so do not drive. You may want to use a heating pad or hot water bottle that night if your back is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one.

Thoracic Epidural Steroid Injections

Once again, please see ar Lumbar Epidural Steroid Injections for general information including possible side effects and things to do before you show up.

The Injection: The patient is brought into the operating room and are usually in the sitting position bending forward with a pillow in their lap to squeeze and hold onto. This helps open up the spaces between the bones of the thoracic spine, which are very narrow. An x-ray machine is brought in to take real-time photographs of the back during the injection. A generous amount of local anesthetic is placed at the level of interest with a very small gauge needle. This is followed with a special epidural needle, which is advanced under fluoroscopic guidance into the thoracic epidural space. This may or may not be confirmed with radiopaque dye and fluoroscopy. Then a solution of local anesthetic or normal saline with steroid is injected. The patient remains in the surgery center for 30 to 45 minutes for evaluation. Complications: Please note an additional complication of this particular injection may be air or fluid around the lung, which is called a pneumothorax or a hemothorax. It is very important for the patient to sit extremely still during this injection to help prevent this. Your pain physician will inform you of all complications as with any other procedure before the procedure is performed. After the injection you may get immediate pain relief or it may take several days. If local anesthetic is used your legs or thoracic region may be weak or numb for several hours so do not drive. You may want to use a heating pad or hot water bottle that night if your back is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one.

Transforaminal/Selective Nerve Root Injections

Please see the general information under Lumbar Epidural Steroid Injections including possible side effects and things to do before you show up.

The Injection: These injections are done in the operating room on the  operating room table with fluoroscopic guidance. They are usually performed in the face down or prone position on the operating room table. Antiseptic solution is placed over the low back or cervical or thoracic region at the site of the injection. Under sterile technique a generous amount of local anesthetic is placed with a very small gauge needle over that site. This is followed with a special epidural needle, which is advanced under fluoroscopic guidance until a specific nerve root is targeted. This is then followed with a solution of either normal saline or local anesthetic and steroid. The patient is once again kept in the surgical suite for 30 to 45 minutes for evaluation during and after the procedure. After the injection you may get immediate pain relief or it may take several days. Complications: If local anesthetic is used your legs, arms or thoracic region may be weak or numb for several hours so do not drive. You may want to use a heating pad or hot water bottle that night if your back is sore. Upon your next visit be prepared to tell your doctor what level your pain went to and whether it has returned to that level or a lower one.