Cervical, thoracic and lumbar interlaminar epidural
injections
Epidural steroid injections
An epidural injection
delivers steroids into the epidural space around
spinal nerve roots to relieve pain - back pain, leg
pain, or other pain—caused by irritated spinal
nerves. The steroid used in the epidural steroid
injection reduces the inflammation of those nerves,
which is often the source of the pain. It is
important to note that an epidural steroid injection
should not be considered a cure for back pain or
leg pain: rather, the goal is to help patients get
enough pain relief in order to be able to progress
with their rehabilitation program.
An epidural steroid injection significantly reduces
pain for approximately 50% of patients. It works
by delivering steroids directly to the painful area
to help decrease the inflammation that may be causing
the pain. It is thought that there is also a flushing
effect from the injection that helps remove or "flush
out" inflammatory proteins from around the structures
that may cause pain. In addition to relieving pain,
the process of natural healing can occur more quickly once
the inflammation is reduced.
Spinal nerves can become inflamed due to irritation
from a damaged disc or from contact with a bone spur.
Depending on which part of the spine the inflamed
nerves are located in, pain and/or other symptoms
(such as numbness, tingling) may be experienced in
different areas of the body, as shown:
Nerve irritation in the cervical spine
-
Neck pain,
or tingling, numbness
-
Shoulder pain, or tingling, numbness
-
Arm pain, or tingling, numbness
Nerve irritation in the thoracic spine
Nerve irritation
in the lumbar spine
Anatomy of the spinal nerves and dura
There
is a membrane called the dura covering the nerve
roots in the spine. Around the dura is a sleeve-like
space called the epidural space. Before nerves can
travel from the spine into the arms, chest, and legs,
they travel through the epidural space, and exit
through small nerve holes. The medication from
the epidural steroid injection is placed in the epidural
space.
Epidural steroid injection procedure
The injection procedure for an epidural includes
the following steps:
-
An IV is started so that medicine can be given
for relaxation if desired.
-
The patient lies face down on an x-ray table
and the skin is well cleaned with an antiseptic.
-
The area where the epidural needle will be inserted
is numbed with a local anesthetic.
-
Fluoroscopy (a guided X-ray procedure where the
doctor can watch the placement and movement of
the needle) will be used to direct a small needle
into the epidural space. The patient will feel
some pressure during this part. Fluoroscopy is
important in this procedure to help ensure correct
placement of the medications.
-
A contrast dye is injected to confirm that the
medicine spreads to the affected nerve(s) in the
epidural space.
-
A combination of numbing medicine (an anesthetic)
and time released anti-inflammatory medicine (a
steroid) is injected.
The procedure usually takes approximately 30 minutes,
followed by about 45 minutes of recovery time at
the clinic. On the day of the epidural steroid injection
the patient should not drive. Rest is needed
and strenuous activities must be avoided on the day
of the epidural steroid injection.
Epidural injection results and follow-up
Following
the epidural injection, some partial numbness from
the anesthetic may occur in the patient’s
arms or legs. Any partial numbness usually subsides
after a few hours. Any remaining pain needs
to be reported to the physician, and ideally the
patient should keep a "pain diary" to record
the pain relief experienced over the next week. After
the pain diary is returned to the treating physician,
the physician should be kept informed of the results
in order to plan future tests and/or treatment if
needed.
There may be an increase in the patient’s
pain that may last for up to several days. This
may occur after the numbing medicine wears off but
before the steroid has had a chance to work. Ice
packs may help reduce the inflammation and will typically
be more helpful than heat during this time. Improvements
in pain will generally occur within 10 days after
the epidural injection, and may be noticed as soon
as one to five days after the injection.
Regular medicines
may be taken after an epidural steroid injection.
On the day following the procedure, the patient may
return to his or her regular activities. When the
pain has improved, regular exercise may be resumed
in moderation. Even if improvement is significant,
activities should be increased slowly over one to
two weeks to avoid recurrence of pain.
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