Epidural Steroid Injection
In a standard epidural pain block, injections are made into the spinal canal between the membrane surrounding the nerve roots and the interior surface formed by the vertebrae. For transforaminal epidurals, injections are into the opening at the side of the spine where a specific nerve roots exits. Epidurals target pain from conditions such as radiculopathy, spinal stenosis and other back/neck disorders.
Radiculopathy is inflammation or damage to a nerve in the neck or the low back. Usual symptoms are pain shooting from the lower back down into one or both legs, or pain leading from the neck into the arm. A herniated disc can cause radiculopathy.
With spinal stenosis, the lower spine becomes narrowed and compresses the nerves inside. This usually causes pain in the buttock or leg, and is characterized by an increase in pain with activity and a decrease in pain when leaning forward.
During the Procedure
The patient lies facedown on an x-ray table while numbing medication and then steroids are injected into the targeted area of the spine using fluoroscopic guidance for precise delivery. The procedure takes 15 to 30 minutes, with about 45 minutes recovery. Discomfort during the procedure should be minimal.
If a patient desires further sedation, that is certainly available. Usually this isn’t necessary and sedation does increase recovery time. Whether or not the patient is sedated, Dr. Dumitru requires that after an epidural, a patient be driven home by a second party.
Patients are advised to take it easy and not return to work or other taxing activities until the next day.
Degrees of response vary widely but in general, epidurals seem to work for at least half of patients. For those who do not experience notable neck/back pain relief after an epidural, subsequent injections are not advisable. But for a patient who experiences at least some degree of improvement, additional epidurals may be performed about two weeks apart. Dr. Dumitru does not conduct more than three epidurals in a six-month period. If pain returns before six months are up, alternate treatments are pursued.