Epidural
Steroid Injections
An epidural
steroid injection is a spinal injection procedure that deposits
potent anti-inflammatory corticosteroid at the site of the painful
reaction to disc injuries or spinal stenosis. Approximately 80%
of patients experience good to excellent results of decreased
pain and increased function. The closer to the time of injury,
the higher the success. For some patients, the relief is long
lived. Other patients may require repeated injections. For those
with temporary relief, the diagnostic information is useful for
planning other procedures or treatment.
The standard
of care is to provide spinal injections under fluoroscopy (live
x-ray) in a safe, sterile operating room that meets state and
federal standards. Please refer to "The
Standard of Care" page.
There are
several routes and variations of epidural steroid injections.
All should employ: the x-ray guided placement of a needle into
the spine under local anesthetic; injection of x-ray contrast
to demonstrate what structure is being injected to increase safety
and accuracy; injection of some numbing local aneshtetic into
the spine; and the injection of the corticosteroid.
Dr. Jasper
is the local expert in all these techniques. To learn more, call
(253) 564-2009 to schedule a consultation.
Risks are
associated with any medical procedure. Fortunately, the risk of
serious complications such as paralysis, nerve damage, or death
is rare with x-ray guided spinal coticosteroid injections.
Improvement
in your symptoms will usuall occur about 2-3 days after the injection.
Write down some brief notes daily as to what is improving: comfort,
function, numbness, frequency of attacks, sleep or mood. If you
are having side effects, please refer to "Corticosteroids."
Types
of Epidural Steoid Injections
Interlaminar
- across the middle of the back; still requires fluoro to be accurate
and safe. Medication is introduced into the most posterior portion
of the spinal canal, often missing the area of inflammation.
Transforaminal
- this is a side sneek approach that enters via a specific spinal
nerve opening. Medication can be delivered into the anterio portion
of the spinal canal very close to the site of injury. A selective
nerve block results that may help with diagnosis as well as trreatment.
Single - sometimes
one injection spreads the medication adequately and gets the job
done.
Multilevel
- It may be necessary to inject at more than onelevel to obtain
coverage of all suspected structures involved in causing your
pain so that the treatment has a better chance of working. The
spread of x-ray dye helps determine if this is necessary.
Caudal
Epidural Steroid Injection -
is used to treat sacral and lower lumbar nerve root pain such
as sciatica. Often, other types of injections will be tried first.
During a caudal injection, the doctor inserts a needle close to
the tailbone into the spinal canal. A fluoroscope x-ray will help
guide the injection for accuracy, safety, and increased efficacy.
An x-ray contrast is used to outline the spinal canal, nerve roots,
and scar tissue. A catheter may be guided through the needle to
the problem area to increase the accuracy and chance of success.
This procedure typically requires 30 minutes or less.
Lysis
of Epidural Adhesions / Modified Racz Procedure
- When scar tissue or inflammation is significant, it may prevent
the injected medications from reaching the problem disc or nerve
root. Adhesiolysis means breaking up the scar tissue, helping
to separate the scar tissue from the nerve roots. Once achieved,
injected corticosteroid has a better chance of working. Adhesiolysis
can be achieved with water pressure and mechanical force. Typical
Time: 20~40 minutes.
Spinal
Endoscopic Adhesiolysis - This
version of adhesiolysis adds the dimension of fiberoptic video
microscopic visualization and a more sturdy and steerable catheter.
This is useful in picking apart the scar tissue. (Insurance may
not pay for this newer procedure.) Typical Time: 45~90 minutes.
