Epidural Injections

What is an Epidural Injection?

An epidural injection is an injection of medication into the epidural space. The epidural space is a space located within the spine, just outside of the sac containing spinal fluid (CSF).

The injection is performed through 3 different routes:

• Transforaminal route: This technique allows accurate injection of medication next to a nerve that is thought to be sending painful signals to the brain. This targets the specific nerve root to control inflammation and pain.
• Interlaminar route: In this technique, the needle is inserted from the back of the spine and the medication is deposited into the epidural space. Here the medication is not delivered near the target nerve root, and the medication spreads freely within the epidural space.
• Caudal route: This method is used control widespread or diffused pain. Here the medication is not delivered directly in the epidural space and around the nerves. Though less effective, this approach is considered safer and easier to perform.

How is the Injection Preformed?

The patient lies on his/her stomach. With continuous monitoring of the patient, the skin on the target area (back or neck) is painted with an antiseptic solution and numbed with the local anaesthetic. Using either fluoroscopic guidance (real-time x-ray) or ultrasound guidance, the needle tip is placed at the targeted area & its position is confirmed with the help of the contrast (dye). Then, a low volume anaesthetic with anti-inflammatory medication is injected. Then the patient is monitored in the recovery room prior to discharge
The procedure takes approximately 30 minutes.

How do the Epidural Injections Work?

The strong anti-inflammatory medication injected into the epidural space reduces the inflammation of the nerve roots as they leave the spine and provide good pain relief. This will not cure the underlying spinal problems (such as, herniated or bulging disc, etc) that is causing the pain, but will give a very good pain relief.

Who are the Eligible Candidates for Epidural Injections?

Most common back pain conditions treated includes:

• Herniated disc
• Disc degenerative disease
• Spinal stenosis
• Back pain not relieved after spine surgery
• Localised back pain
• Back pain & leg pain worsened with walking for few steps

How long does the Effect Last?

The effect might last a few weeks to few months, or sometimes much longer. If there is significant improvement in pain, no further injection is needed unless the pain recurs. Whenever the pain recurs, the injections may be repeated for an added benefit in future.

What is the Next Step after the Injection?

It is very important for you to maintain the PAIN DIARY following this injection and bring it with you during your next follow up visit with Doctor. This will guide us to measure your response to the treatment and decide the next most appropriate plan.

What are the Risks and Side Effects?

Serious side effects and complications are very rare. Pain at the injection site, local bruising, headache, nausea, fainting, or dizziness are some of the most common side effects, which are transient and will subside on their own. The other uncommon complications are infection, bleeding and nerve injury. These complications are minimized by stopping blood thinners, using sterile technique, and fluoroscopic or ultrasound guided needle placement.

What should be Done After an Epidural Injection?

• Avoid self-drive on that day alone.
• Avoid doing strenuous activity.
• Avoid lifting heavy weights.

Following the treatment, the patient is advised to do all the exercises and take all the medications as prescribed. The patient may resume their work from next day.

For what Reasons should you Immediately Contact the Doctor after the Injection?

If you experience severe back pain, new onset of numbness or weakness of legs, loss of control of your bladder or bowels, or signs of infection in the area of the injection like fever or pus at the injection site, kindly immediately contact your doctor.