Epidural Injections

Background

The epidural space is within the spinal canal and surrounds the spinal cord. Steroid injections into the space can help to decrease inflammation of the nerves and other soft tissues in the identified problem area. These injections are usually given in a set of three for a cumulative effect. They are used for problems such as: Herniated discs, Sciatica, Narrowing of the spinal canal (Spinal Stenosis) and occasionally for Discogenic Low Back Pain. They can be given in the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), and at the level of the tailbone (caudal approach).

The membrane that covers the spinal cord and the nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the back and into the legs/arms. Inflammation of these roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.

General Pre/Post Operative Instructions

Patients may eat a light meal within 4-6 hours before the procedure. If patients are insulin dependent diabetics, they must not change their normal eating patterns prior to the procedure. patients may take their routine medications (i.e. high blood pressure, cardiac, thyroid and diabetic medication). Patient should not take pain medications or anti-inflammatory medications the day of the procedure. If patients are on Coumadin (blood thinners) or Glucophage (a diabetic medicine), they must notify the office so that the timing of these medications can be explained. Patients are generally asked to be at the facility one hour prior to the procedure and can be at the facility for approximately 2-3 hours. A driver must acompany the patient and be responsible for getting him/her home. No driving is allowed the day of the procedure. The patient may return to work, the day after the procedure.

During the Procedure

An IV is started so that relaxation medication can be given. The physician numbs a small area of skin with numbing medicine. The medicine will sting for several seconds. After the numbing medicine has taken effect, the physician will direct a small needle, using X-ray guidance into the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) medicine is injected. During this entire procedure you will be attached to various monitoring devices and will be asked to breath oxygen through your nose. This is all routine. The approximate time for the procedure is 30 minutes.

After the Procedure

The patient is returned to the post operative Same Day Surgery area where they are monitored for 60 minutes. A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three (3), about two (2) weeks apart. The back of the legs may feel weak or numb for a few hours. This is to be expected, however it does not always happen. You will be given discharge instructions before you go home.