Epidurals are injections of medications directly into the membrane surrounding the spinal cord, called the dura. This membrane is highly vascular and close to the nerve roots, making it the ideal place to inject steroids and analgesic medications. Epidurals come in three types, depending on where the nerve impingement has occurred. Caudal epidural injections are performed at the bottom of the spinal cord for nerve involvement between the fourth lumbar vertebra and the fourth sacral vertebra.
Lumbar epidurals are administered for nerve impingement between the first and fifth lumbar vertebrae, and cervical epidurals are prescribed for impingement between cervical vertebra three and thoracic vertebra one.
BASIC Spine pain management doctors and spinal surgeons can perform all three of these types of injections, but the most commonly administered of them are the lumbar and cervical epidurals. All of them follow approximately the same course of administration, and tend to focus on disc problems in the neck or lower back. After a thorough assessment of your spinal condition, the appropriate injection can be selected. You may need to obtain x-rays and MRIs of the area in question to determine the best injection for your specific back problem.
Lumbar Cervical Epidurals Indications
Epidural injections are indicated for a number of spinal conditions. Disc tears, called annular tears, are a common reason for this procedure, and they are generally caused by the decrease in water in the disc from degenerative disc disease. Of course, simple herniation of a disc that impinges a nerve root is the most common reason for an injection, and this procedure can treat discs that have herniated in the neck or lower back. By bringing the anti-inflammatory medication to the site of disc herniation, the swelling in the area decreases and helps to free the nerve.
Stenosis is another possible reason for getting a steroid epidural. Spinal stenosis is the narrowing of the channel that the spinal cord rests in. This can cause compression of the cord itself and pain in the related nerve roots. Foraminal stenosis is the narrowing of the small passageway that contains the nerve root itself. Disc herniation can cause this stenosis, but fractures, arthritis, and abnormal curvatures of the spine can cause it, as well. Finally, spondylolisthesis can cause nerve root compression and benefit from a steroid injection. This condition occurs when one vertebra slips forward out of alignment with the vertebra beneath it. The slippage can impact nerve roots, causing pain, and it generally responds well to steroid epidurals.
Lumbar Cervical Epidurals Procedure
Lumbar and cervical epidural steroid injections are performed in the office using our state of the art equipment. A technician will start an intravenous line in your arm that will allow the administration of sedation medication directly into the blood stream. Through this line, we will give you medications that will help you relax but not put you to sleep. Once you are comfortable, you will be positioned on your left side and the appropriate area will be exposed. You will likely need to remove your shirt for cervical injections and your pants and shirt for lumbar injections. A local anesthetic will be administered into the skin over the problem area, and the needle will be carefully inserted between the spinous processes toward the target site.
The doctor will use special moving x-rays called fluoroscopy to guide the catheter tip to the correct location. For lumbar epidurals, the injection is usually placed between L1 and L5. For cervical epidurals, the needle is placed either between C6 and C7 or C7 and T1. Once the needle is in the proper place, contrast fluid will be injected to double check the placement. After confirmation, the mixture of steroids and anesthetic will be slowly injected. You may feel some pressure at this point, but it should not be painful. The needle is then removed, and you are allowed to recover.
Lumbar Cervical Epidurals Results
After the injection, you will need to remain on the affected side for at least two hours to allow for the distribution of the steroid. For cervical injections, we may tilt the head of the bed downward to allow gravity to pull the medication up into the cervical region. You will need transportation to and from your appointment due to the sedation used in the procedure. Some side effects include numbness and tingling and short-lived exacerbation of the original pain. In fact, some patients experience immediate relief due to the anesthetic, but have pain a few days later when the anesthetic wears off. After another day or two, the steroid kicks in, and the pain should decrease.
Epidural steroid injections are generally safe and quite effective in decreasing the amount of pain due to nerve root impingement, such as sciatica. Complications are rare, but they can occur. One relatively common side effect is an epidural headache that generally lasts for a few days. Rarely, they may persist and require a further procedure, known as a patch. Seizures, allergic reactions, and dural punctures are also possible. Long term side effects include a continuance of the pain, bleeding, and abscess formation.
BASIC Spine has several doctors on our team who are capable of safely and effectively administering steroid epidural injections in the cervical or lumbar regions. We have the state of the art fluoroscopy equipment on site to quickly and conveniently administer these treatments. If you have pain that is not responding to more conservative treatments, contact us at one of our convenient locations for a consultation.