Lumbar Spine Epidural

Using image-guidance fluoroscopy (x-rays that show your body in real-time), your doctor will place a long needle into the epidural space, the area surrounding the dural sac containing nerve roots and cerebrospinal fluid. A combination of steroids and anesthetic (numbing) medication are then injected for pain relief.

Depending on the underlying back problem and the specifications of the referring clinician, the epidural injection will most likely be either interlaminar or transforaminal in location. An interlaminar injection typically spreads over a larger area, affecting multiple nerve roots on both sides of the body.  A transforaminal injection, often called a nerve block, is targeted to one nerve root at a specific spinal level and one side of the body.  Multiple transforaminal injections can be performed during a single visit.

This pain relief may enable you to undergo necessary conventional treatment, such as physical therapy, to rehabilitate your back.

When you arrive for your procedure. a clinical staff member will greet you and let the team know you’ve arrived. You will be brought into an exam room and asked to change into a gown. Your doctor will greet you, explain the procedure and answer any questions you may have.

You will lie prone on your stomach on the exam table for this procedure.  Your doctor will clean the area with an antiseptic solution and cover it with a surgical drape. Your doctor will then give you a shot of local anesthesia to numb the area. You will feel a small pinch as the anesthesia is administered.

Once the area is numb, your doctor will use either fluoroscopic imaging (which uses X-rays to guide the needle) or CT scans, to administer the steroid injection. Your doctor will slowly guide the needle into the appropriate space in your spine. Once the needle is in place, your doctor will inject the medication. You may feel some discomfort as the medicine enters the epidural space. This should only last a short moment and will most likely dissipate after the injection is complete. Once the medicine has been administered you may feel some tingling. You should tell your doctor if you feel any sharp pain.

In most cases, this procedure takes only a few minutes. Once the procedure is complete, the needle will be removed and you will likely have a small bandage over the puncture. You may need to stay in the doctor’s office for a short while (perhaps an hour) until you feel ready to go home.

You may feel some difficulty walking or standing up/sitting down immediately after the procedure. This should subside within a few hours. Your doctor will likely tell you to rest for the remainder of the day but you may resume your normal activities the following day.

The injection may not have immediate pain-relieving effects but you will likely feel lessening pain over the next two days. This pain relief can last anywhere from a few days up to a few months and in some cases longer, depending on your case.

Your doctor will discuss any need for a follow-up visit before you leave.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or – as you’re doing now- educate yourself about the procedure.

Another important part of your preparation will be guided by your doctor:

• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.

Some of your preparation will need to be timed to the procedure:

• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions, and will ask if you have any questions.
• Take your medications as instructed.
• When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or x-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.

• A CD of your most recent MRI of the spine if those images were not obtained at Jefferson Radiology or a Hartford Healthcare affiliate hospital/imaging center location.
• Wear comfortable, loose-fitting clothes
• Wear comfortable shoes
• Avoid bringing jewelry or valuables

The benefits of Epidural Injection could be:

• The beneficial effects of the steroid injection usually require 2-3 days to take hold, but may take as long as 5-7 days
• Pain relief
• Reduce inflammation which may lead to healing

Risks you should be aware of include:

• As with any procedure, there is a slight risk of infection
• Rarely, this procedure can cause a temporary increase in pain
• Epidural injection may cause headaches, this is rare
• Rarely there are reactions to the pain mediation such as rash or hot flashes
• There is a slight risk of nerve damage at the injection site
• There is a slight risk of bleeding
• If fluoroscopy is used, there are risks associated with exposure to X-ray. You should discuss these with your physician

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.