An epidural injection (ESI) is a minimally invasive procedure that may be used to manage back, neck, arm and leg pain. It is also used to help improve mobility in the lower back and legs. During this procedure, an orthopedic doctor injects a local anesthetic and a steroid medication directly into the epidural space that surrounds the spinal cord and nerve roots.
Epidural injections are used to treat radicular pain caused by nerve irritation. This type of pain is usually caused by herniated discs or spinal stenosis. A herniated disc occurs when pressure or degeneration produces a tear in the disc’s outer ring (the annulus), and the nucleus ruptures out of its normal space. If it rips near the spinal canal, the bulging disc can push out of its space and into the spinal canal, placing inappropriate pressure on the spinal cord and nerve roots. Spinal stenosis is a narrowing of the spinal canal that can cause pressure on the spinal cord and spinal nerves.
Epidural injections are also helpful when the main problem is arthritis of the facet joints in multiple areas of the spine. The medication coats the outside of the problem joints and absorbs into the joints. This type of injection reduces the inflammation in the joint. The injection is sometimes aimed at the small nerves that supply the joints.
Epidural injections may be used to provide pain relief so that a patient can participate in physical therapy, which may help to eliminate the need for a surgical procedure. Injections may also be used to delay a surgical procedure.
It may be necessary to have several epidural injections in a series over a period of a few weeks. This is because the relief from the epidural injection usually decreases with time. It is not uncommon to have three lumbar epidural injections, each about ten days apart.
Your doctor will discuss the benefits and risk associated with epidural injections if it is determined that you are candidate.
Preparing For An Epidural Injection
You will probably be asked to arrive early to fill out paperwork and answer some questions. Your doctor will want to verify that you are ready for the procedure.
You may be asked to come in “NPO”. This means you should not have anything to eat or drink for at least six hours before the procedure. This reduces the risk of vomiting food or liquids if you should become nauseated or have a reaction to the medications. Nausea is unpleasant, but it can also cause serious complications if you accidentally inhale (aspirate) food or liquid into your lungs while you are groggy. Not having anything in your stomach during this procedure is an extra precaution highly recommended by most health care providers.
You will probably be asked to change into a hospital gown. You will then be connected to a device that monitors your heart rate (pulse) and blood pressure. An intravenous (IV) line may be started in your arm. You may be asked to sit on a stretcher or lie on your side for the procedure. The area of the back will be prepared with an antiseptic. Lidocaine may be injected to numb the skin around area where the epidural will be performed.
Orthopedic Pain Management at The CMD
Our team of Pain Management Doctors and Orthopedic Spine Surgeons at The Center For Musculoskeletal Disorders use epidural injections and other non-operative treatments to reduce back pain. After reviewing a patients medical history, a physical exam, and imaging test our providers can determine and discuss the best individualized treatment options available.
The majority of patients who visit our orthopedic centers are able to manage their pain without surgery. If a a patients doesn’t respond to non-operative treatment methods and surgery is recommended, our Spine Surgeons use the most current and advanced surgical techniques to help return you return to your lifestyle.