Epidural injection
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
What is the epidural space?
epidural space and dura
The membrane that covers the spinal cord and 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 (or to the neck and into the arms). Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.
What happens during the procedure?
An IV is started so that relaxation medication can be given. If you do not wish to receive sedation, the IV is optional. However, as a safety precaution in case of an allergic reaction to the injected solution, an IV is highly recommended for the first injection. You are placed on your stomach on the x-ray table. For cervical injection, you will be placed on your back or your side. The skin on the back is painted with an aseptic solution Betadine. Next, the physician numbs a small area of skin with an anesthetic (numbing medicine). This medicine stings for several seconds.
After the anesthetic has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure proper needle position in the epidural space as well as to rule out any evidence of adhesion, bony narrowing, nerve root constriction, or possible nerve root inflammation. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. For two level epidural, the above procedure is repeated for the second level. The procedure usually takes about 10-15 minutes.
What happens after the procedure?
You are then returned to the recovery area where they are monitored for 15-30 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. If you do not have any improvement with the first injection, please see your doctor prior to the second injection as it may not be necessary to perform the second injection. Approximately 10% of patients may experience slight increase of pain one (1) to three (3) days after the injection. The back or legs (or neck and arms in case of cervical injections) may feel weak or numb for a few hours. You will be given additional warning signs to look for on the day of the procedure.
Risks and Complications
Epidural injections performed under X ray guidance by an experienced physician are extremely safe. Potential complications including infections, bleeding, nerve injury, headache, paralysis could happen but they are highly unlikely to occur. Dr. Tran has performed over 3000 epidurals without any complications. Cortisone that is used, Depomedrol/Celestone/Kenalog, is the similar cortisone produced by your body, and it is not the illicit version used on the “street”. There are no known long term side effects with a series of three epidurals per year. If you are a diabetic, your blood sugar level may rise for 1-2 days after the injection.
General Pre/Post Instructions
If you choose to have IV sedation, you must not eat or drink within 6 hours of the procedure. Otherwise, you can eat a light meal within one-two hours before the procedure. You may take your routine medications with sips of water (i.e. high blood pressure and diabetic medications). You have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. Please inform your physician if you are taking Aspirin or blood thinner medications (Coumadine). These medications must be stopped (per the approval of your private physician) at least 7 days prior to the procedure.
You are generally asked to be at the surgery center one hour prior to the procedure and can expect to be at that facility approximately 2-3 hours. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure if you receive sedation. You may drive if you do not receive sedation, though, this is not recommended. Icing of the area is recommended for the first day. You may return to your normal activities the day after the procedure, including returning to work.
How does the scheduling process work?
The office will call your insurance carrier to obtain authorization for the procedure. This process may take from a few days to a month depending on your insurance. You may call this office in two weeks to check on the authorization status. You may also call the insurance directly to make inquiry. Once authorization is given, our scheduler will call you to set up the appointment. Injections are done on Thursday only at Los Gatos Spinal Diagnostics Surgery Center and occasionally at Forest Surgery Center. A map and letter of confirmation will be mailed to you.
If You Still Have Questions
Please call the clinic where you were seen and make an appointment with Dr. Tran so that your questions can be answered. It would be best that your questions are answered in person rather than over the phone.
