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Epidural Injection

Epidural injections are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Most practitioners will agree that, while the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program.

Lower Back Pain Treatment

Lower Back Pain

How Epidural Injection Work?

An epidural injection delivers medicine directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ inflammatory mediators from around the area that may be a source of pain.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Several common conditions that cause severe acute or chronic low back pain and/or leg pain (sciatica) from nerve irritation can be treated by injections. These conditions include:

  • A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves. Read Lumbar Herniated Disc for more information on diagnosis and treatments.
  • Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back.
  • Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain.
  • Compression fractures in a vertebra.
  • Cysts which are in the facet joint or the nerve root and can expand to squeeze spine structures.

The epidural injection procedure takes place in a surgery center, hospital, or a physician’s clinic.

Epidural Injection Pain Relief Success Rate

Patients will find that the benefits of an epidural steroid injection include a reduction in pain, primarily in leg pain (also called sciatica or radicular pain). Patients seem to have a better response when the epidural injections are coupled with an organized therapeutic exercise program.

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Guided Injection (Epidural) for Lower Back Pain

A lumbar epidural injection is a safe and effective minimally invasive treatment for the treatment of certain types of low back pain.  This type of spinal injection reduces nerve inflammation, calms symptoms, aids healing and, provides the physician with important diagnostic information.

The procedure involves injecting a corticosteroid into the epidural space.  A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective at reducing inflammation. Sometimes a narcotic is injected to increase pain relief. The epidural space is between the protective membrane (dura mater) that covers the spinal cord and the bony spinal canal. After medication is injected, it flows and coats the nerve roots.

Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.

Many spinal problems cause low back and leg pain (sciatica).

Basics about Lumbar Spinal Nerves

There are 5 pair of spinal nerves In the lumbar spine. Each pair of nerves provides sensation and function to specific parts of the body. The spinal nerve pairs are numbered to correspond with the adjacent vertebral level. The nerve roots at L1 exit at the left and right between the first and second lumbar vertebrae (L1-L2).  L5 exits between the last lumbar vertebra and the sacrum (L5-S1).
Each pair of nerve roots exit the spinal column and branch out into the body forming the peripheral (outer) nervous system.  These nerves innervate the lower part (below the waist) of the body and enable movement (motor function) and feeling (sensory function). Dermatones are skin areas innervated by spinal nerve roots. Physicians use dermatomal patterns to help diagnose the location of certain spinal problems based on where the patient reports pain or weakness.
Based on symptoms, medical history, physical and neurological examination, and imaging study findings (x-ray, MRI), the physician can determine the spinal nerve root(s) associated with pain and other symptoms.

Patient Procedure Preparation

Some types of medications have to be stopped several days before the procedure.  Certain medications increase the risk for bleeding.  The physician may ask the patient to stop pain medication, including anti-inflammatory drugs to determine the full effectiveness of the lumbar epidural injection.

Possible Risks and Complications

Any medical procedure poses risks or possible complications. Although rare, possible risks or complications include bleeding, infection, nerve injury, and allergic reaction to medication.  Furthermore, the injection may increase pain and cause tenderness at the injection site.  The physician discusses all potential risks and complications with the patient well in advance of the procedure date.

What to Expect: The Procedure and After

The procedure is performed in a sterile setting.  After checking into the facility, the patient changes into a hospital gown and lies on the treatment bed, and an intravenous line is started through which medications are administered.  Relaxing medication is given; complete sedation is not necessary.

In the procedure room, the patient is positioned face down with a cushion placed under the abdomen.  This keeps the spine in a flexed position and the patient comfortable.  The skin area is cleansed using a sterile solution.  Local anesthetic is injected to numb the injection site.

Fluoroscopic imaging equipment called a C-arm is positioned over the patient.  During the procedure fluoroscopy captures x-rays in real time and displays the images on a monitor. Under fluoroscopic guidance, the physician inserts the needle and injects a small amount of contrast (dye) to verify needle placement.  Next, an anesthetic and corticosteroid is injected into the epidural space.  Pain may temporarily increase during the injection. The physician asks the patient for feedback during the procedure and makes the patient as comfortable as possible. When the injection is over, the injection site is covered with a small bandage.

A lumbar epidural injection treatment may involve one or more injections. The procedure takes about 15-minutes. After the procedure, the patient is moved into the recovery area where the nurse monitors vital signs.  Soon, the patient is discharged with written home care instructions.

Some patients experience discomfort after the procedure for two or three days. This is normal and does not necessarily mean the corticosteroid is not taking effect. Typically, the physician’s office will call the next day to follow up. Some physicians recommend that patients keep a daily record of pain levels and symptoms following a lumbar injection to provide the medical team with information that could guide further treatment.

Conclusion

Lumbar spinal injections have provided significant pain relief to many people with moderate to severe low back pain. Not everyone is an appropriate candidate for this procedure, and prospective patients should discuss risks and benefits with their physicians.

For more Information, please call +65 6471 2744 or Email to: info@boneclinic.com.sg