Epidural in Treatments
Epidural Steroid Injections
What are epidural steroid injections?
Epidural steroid injections are commonly used to treat the syndromes with a pain described as “radicular pain”. The word radicular means the “root”, and it refers to an irritated nerve root – “radiculitis” or weakness of an affected nerve root – “radiculopathy”.
How is an epidural performed?
- Will take less than 30 minutes to complete
- Will be performed under light sedation
- Delivers medications including local anaesthetics, steroids and even opioids or hyalase (scar dissolving chemical) into the epidural space (between the bone and the protective sac of spinal nerves) with ultrasound or X-ray guidance
- It then decreases the inflammation allowing you to resume your normal function
Your doctor will decide which specific type of epidural steroid injections is most beneficial to you based on your medical history, physical exams performed and the cause of your pain.
What are the different epidural injections?
- Interlaminar approach:
- A fine needle will be inserted in between the spinous processes (those bony prominences in the middle of your back) and guided into the epidural space
- It is the same approach that is used in the labour epidurals for pregnant women who are about to deliver
- Transforaminal approach:
- A fine needle will be inserted towards the opening in the spine (the foramina) where the nerves emerge out from the spinal cord.
- It targets the nerve which is pinched by the disc or bony spur
- Thus leading to the best result for treating sciatica amongst the different approaches for epidural
- Caudal approach:
- Injections are delivered into the epidural space by your tailbone
- It allows for a catheter (Racz catheter) to be placed and increases the volumes of steroids and anaesthetics to be administered
- It is usually recommended when you have had a back surgery which sometimes distorts the anatomy
You will feel better about 30 minutes after the injection, but the pain may return once the local anaesthetic effect wears off. The pain relief will then improve again in 2-3 days and it can last for months to years depending on each individual. If the pain ever comes back (but the injection has helped before), then the procedure can be repeated around twice a year.
Am I a good candidate for epidural steroid injections?
If you have lower back pain over 3 months in duration and sciatica that has not improved with conservative management arising from:
- Spinal stenosis
- Herniated discs
- Degenerative disc disease
A majority of back pain and sciatica will improve by themselves. However, if the pain is unbearable and disabling, an injection may speed up the recovery process, allowing you to return to normal activities as soon as possible.
What are the possible risks?
There is a very low risk of infection, bleeding and nerve damage. You may temporarily experience numbness, weakness, delay in passing urine and nausea. Rarely the pain may worsen for a short period before improving.
What should I expect after the procedure?
Your doctor will recommend some back exercises to strengthen your back muscles that support your back to reduce the chance of the pain returning. You are also advisable to maintain a healthy body weight and a balanced diet with fruits and vegetables.
Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.