The spine has many diseases that result in painful inflammation of nerves, ligaments, and discs that may respond to epidural steroid injections. These conditions include disc herniations, spinal stenosis, and arthritis of the spine. Epidural injection provide relief from pain when there is inflammation. Disc herniations are commonly known to produce inflammation of the nerves due to spilling out noxious chemicals from the disc onto the nerve root, causing pain from the back to the hand or foot depending on the location of the disc herniation. The epidural space is an area behind the spinal cord and spinal fluid that the nerves cross through in order to leave the spine.
WHAT IS AN EPIDURAL STEROID INJECTION?
Epidural steroid injections consist of corticosteroids (not the body builder steroids) that are solids suspended in liquids. The steroids fall out of the solution after injection, and serve as a long lasting reservoir for steroids to gradually dissolve, coating the nerves and relieving some of the inflammation. In the neck, the steroid may contain no solids at all and instead a clear solution of steroid is injected. Epidural steroids will not cure spinal stenosis, do not dissolve or reduce disc herniation size (only surgery or the body’s own enzymes can do this). They do provide moderate relief lasting typically for 3-24 weeks or longer, and permit greater function while the body is attempting to resorb the disc herniation. Spinal stenosis will not gradually improve over time as is possible with disc herniation, and in the case of spinal stenosis, therefore more frequent injections may be needed. There are three approaches to the epidural space of the low back as seen above: the choice of which often depends on your particular condition. In the neck, the needles are placed from the back or side of the neck.
DO THE INJECTIONS HURT?
When performed properly under x-ray guidance, the injections are not very uncomfortable.
bleeding, infection, nerve injury, spinal cord injury, abscess or blood clots, paralysis, spinal fluid leak with headache, and failure to relieve pain are all risks. Discuss specific risks with your physician prior to the procedure during consultation.
Rarely, when sedation is required, you should eat or drink nothing after midnight, continue your normal medications (except those below) with a sip of water, and you should have a driver transport you home.
MEDICATIONS TO STOP PRIOR TO THE PROCEDURE:
Stop Plavix 7 days before the procedure Stop coumadin and warfarin 5 days before the Procedure. Stop Ticlid (ticlopidine) 14 days before the procedure.
If you experience new onset severe generalized weakness during the first week after the injection, call our office. If you develop fever of more than 101 degrees during the first few days after the injection, new weakness or numbness in the arms or legs, severe increase in pain in the back or neck, or loss of bowel or bladder control, notify our office immediately.
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