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Epidural steroid injection:
Epidural injection of steroid and other pain relieving medications has been used for many years for the short term treatment of spinal pain and pain symptoms from a compressed spinal nerve root producung sciatica. The procedure involves injection of steroid medication, usually combined with local anesthetics or ‘novocaine’ type drugs into the epidural space where they can exert their pain relieving effects. In the case of sciatica or leg pain from a herniated disc, studies have shown that the typical duration of benefit is around 2 or 3 months. Since we know that 90% of sciatica symptoms resulting from a herniated disc will resolve in 3-6 months, one or two epidural injections may be all that is needed to provide excellent relief of pain symptoms during the period necessary for natural healing. For patients with sciatica resulting from spinal stenosis, the benefit of epidural injection of steroid is less reliable, and surgery is more often required.
The epidural space communicates with the spinal disc, nerve roots, spinal or ‘facet’ joints, and the tissues which hold them together. Any or all of these structures may be responsible for spinal pain and associated leg or arm pain.
Epidural injections also provide a convenient means of testing pain medications that may later be delivered into the body by intraspinal pain pumps for the long term treatment of serious pain problems in some cases. Pain relieving drugs may be introduced into the epidural space in a variety of ways, depending on individual patient requirements or physician preference. Many physicians also prefer to use x-ray guidance and x-ray dye to confirm precise needle and drug placement. Recent studies have confirmed that x-ray guidance provides the best assurance that steroids and pain relieving medications will be placed as close to the site of the problem as possible.
What to expect:
Patients will enter the pre-op area where vital signs are taken. For those patients needing sedation an I.V. will be started and medications given. Patients will then enter the procedure room and lie face down on the procedural table with a pillow under the abdomen. An x-ray machine will then be used to localize needle placement to the area(s) shown by imaging tests to be responsible for the pain. The skin overlying the site of injection is cleaned with antiseptic solution, and covered with sterile drapes. Local anesthesia will be injected to numb the area where the injection will be performed, and the epidural needle is placed. In most cases radiocontrast dye will be used to confirm spread of medications in the intended location unless allergy to these agents is known or suspected. At the completion of the procedure the needle and any catheters used to direct the placement of medications are withdrawn and a bandaid dressing is applied. For some patients, the epidural catheter will be left in for a few days for a trial of intraspinal medications to determine if a pain pump will be implanted at some future date.