Spinalogy Blogs

Epidural injection is a minimally invasive procedure used to manage and alleviate pain, particularly in the spine. These injections can be administered around the cervical, lumbar, and caudal regions.

The injections are delivered directly to the area surrounding the spinal cord (not inside it) and nerve roots. They are commonly employed to relieve pain caused by spinal nerve irritation or inflammation. Additionally, epidural injections serve both diagnostic and therapeutic purposes in cases involving nerve-related pain.

To enhance accuracy, imaging guidance, such as fluoroscopy or CT scans, may be utilized to help the physician place the needle in the target area responsible for the pain.

Goals of the Procedure

The primary objectives of an epidural procedure are to provide pain relief and reduce inflammation. Epidural injections are generally considered safe.

Epidural injections may be referred to by several names, including:

- Epidural Block

- Epidural Steroid Injection (ESI)

- Neuraxial Anesthesia

Indications for Epidural Injections

Epidural injections are used for various purposes, including:

Diagnosis: To identify the source of pain by observing the effects of the injection.

Pain Management: For conditions such as slipped discs, spinal stenosis, spondylolisthesis, and facet joint issues.

Post-operative Pain: Particularly for post spinal surgery pain syndrome.

Types of Epidural Injections

1. Transforaminal Epidural Steroid Injection:

This injection is administered into the sheath surrounding a nerve root in the spine to temporarily reduce pain while better identifying its source. This method targets specific nerve roots by delivering steroids through the foraminal opening.

2. Interlaminar Epidural Injection:

 In this technique, steroids are delivered to the epidural space by passing a needle between the laminae of two adjacent vertebrae.

3. Caudal Epidural Steroid Injection:

This involves injecting steroids in the coccygeal area (tailbone) to treat chronic lower back pain and leg pain.

Composition of Epidural Injections

Epidural injections typically contain:

Corticosteroids: These injections help reduce localized pain and inflammation.

Local Anesthesia: This component immediately numbs the pain site and helps reduce discomfort. Often, corticosteroids are mixed with local anesthesia for enhanced effectiveness.

Procedure Overview

The procedure requires a team, which include Orthopedic surgeon, 2 nurses and an X-ray technician for fluoroscopy imaging.

Guidelines for Patients:

- Ensure the physician fitness to perform the procedure.

- Do not discontinue any prescribed medications for hypertension, diabetes, blood thinners, or other regular medications without consulting the physician.

- Avoid antibiotics and painkillers unless specifically recommended by the consulting doctor.

- If any morning medications are missed, take them with a small sip of water.

- Follow the NBM (Nil by Mouth) guideline for at least 6 hours prior to the procedure.

After the procedure, patients can often experience significant relief from pain and improved mobility, which can greatly enhance their quality of life. It's important for patients to follow post-procedure care instructions and communicate with their healthcare team regarding any concerns. Overall, epidural injections serve as a valuable treatment option for managing pain associated with various spinal conditions, making them an effective tool in pain management and recovery.