Degenerative conditions of the spine such as a herniated disc and spinal stenosis may compress associated spinal nerves and cause back pain. This pain or numbness may extend to the parts of the body that the nerve supplies such as hips, buttocks, and legs.
An epidural spinal injection is a non-surgical treatment option for relieving back pain. Dr. Vengurlekar usually suggests a non-surgical method to treat back pain, and epidural spinal injection is one of these preferences. In cases where you find no relief from this and other non-surgical methods, surgery is recommended.
Epidural spinal injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as epidural anesthesia given before childbirth to decrease labor pain.
Epidural injections are administered into the epidural space of the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5 mm wide and is filled with spinal nerve roots, fat and small blood vessels.
Pain management in different conditions such as spinal stenosis, disc herniation, and arthritis can be performed through epidural injection. An epidural spinal injection may be employed both for diagnostic and therapeutic reasons.
- Diagnostic Purpose: Medication is administered to determine the specific nerve root involved in the spinal problem.
- Therapeutic Purpose: Medication is administered for inducing short- or long-term relief from pain and inflammation.
It is to be noted that epidural spinal injection is not a curative intervention; rather, it is a treatment tool to reduce discomfort so that rehabilitation programs such as physical therapy may be well executed.
Epidural spinal injection is usually performed on an outpatient basis. The procedure involves the following steps:
- You will be taken to the pre-op area where trained nursing staff prepares you for the procedure by measuring your vitals and reviewing your medications. Blood sugar and coagulation status may also be checked if needed.
- You will then be taken to the procedure room and made to lie face down on a table.
- The injection site is then cleansed and an injection of a local numbing agent is administered in the area so that you don’t feel pain during the procedure.
- A thin hollow needle is then inserted into the epidural space, guided by fluoroscopic X-ray to place the needle in the correct position. This system provides real-time X-ray images of the position of the needle in the spine on a monitor for your surgeon to view.
- A contrast material is then injected through the accurately-placed hollow needle to confirm that the drug flows to the affected nerve when injected.
- When Dr. Vengurlekar is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.
- Finally, the needle is removed, and the injection site is covered with a dry, sterile bandage.
You may feel some pressure during the administration of the injection, but the procedure is generally painless. The procedure takes about 15-30 minutes to complete. After the injection, you are advised not to drive or return to work. You should rest and avoid any vigorous activities. Your surgeon may give specific post-care instructions. Please follow the instructions to recover faster.
Patients may feel numbness in the arms or legs just after the procedure along with other side effects related to the anesthetic component that usually settles down within 1-8 hours. Patients may continue to feel some back pain; epidural spinal injections take about 24-72 hours before showing their pain-relieving action. In some cases, if the desired effect is not obtained, then reinjection may be recommended. The standard guidelines for steroid injections state a maximum of 3 injections per year. In case no relief is obtained from spinal injection, then surgery is considered as the final option.
With any procedure, some risk factors will always be there. Likewise, epidural spinal injections have complications such as bleeding or infection at the injection site, pain during or after injection, post-injection headache, nerve injury, bladder dysfunction, fluid retention, respiratory arrest, epidural hematoma, and spinal cord infarction. Discuss with Dr. Vengurlekar if you have any concerns prior to the procedure.
Scottsdale pain management doctor, Dr. Sham Vengurlekar reveals that recently, there was a discussion from the FDA about corticosteroids in epidural injections. In a committee vote, there was a 15-7 decision in favor of altering labels on epidural injections because particulate steroids offer a number of risks to those that they are used on. The fact is that corticosteroid injections have been the complicating factor in a number of cases, and in the past have even caused death.