Epidural Steroid Injection Procedure
The injection procedure is usually commenced with an intravenous sedative (though this is optional) to help the patient relax, and then the patient is usually positioned face down for stable access to the injection site. An antiseptic swab is used before administering the local anaesthetic, after which the physician will use a fluoroscope to guide them as they insert the needle into the epidural space. A contrast dye is often injected at this point to double check the position of the needle and the affected nerve before injecting the steroid and the anaesthetic themselves. The needle does not enter the membrane (dura) that contains the spinal cord and nerve roots, instead the injection is administered to the epidural space that surrounds this membrane. If the needle does accidentally nick the dura then this can lead to highly undesirable complications. The needle will then be removed and the area swabbed with antiseptic and bandaged.
After the epidural (which takes about 15-30 minutes) the patient is usually monitored for 30-60 minutes and then allowed to leave if everything is satisfactory. Patients should not drive after an epidural and should ensure a partner, friend, or relative is on hand to take them home and help them out with daily activities initially. They should avoid strenuous activity that day also and follow other guidance as given by their physician to aid their recovery.
After the Injection Procedure; Benefits, and Risks
Epidurals can effectively relieve neck pain for a number of weeks, and can help the patient avoid, or reduce, their use of other analgesic medications. An epidural steroid injection may also provide a break in the cycle of pathological inflammation and neck pain which allows the body to begin healing itself. Inflammation is an important physiological response, allowing the body to defend itself and begin repair of tissues. However, when the inflammation gets out of control it can actually hinder the healing process and lead to chronic debilitating conditions such as neck pain.
Frequency of Injections
Patients should view epidural steroid injections as an option for facilitating a shorter term recovery from a specific nerve root issue rather than as a long-term pain management strategy. These injections are rarely given month after month and year after year due to their possible side effects. The majority of neck pain sufferers will not require epidural steroid injections as the pain will be able to be managed by other methods or will subside eventually of its own accord. For those who do have the injections, the physician will usually recommend a limit of three in the space of a year, with at least a two month gap between injections as long-term consequences of this treatment have not, as yet, been confirmed. Three or four injections at one site are the normal limit advised for most patients.
Some of the potential side-effects of epidural steroid injections include the possibility of complications with the procedure itself, namely a risk of infection at the injection site. Side effects can include tenderness for a few days at the site of injection, nausea and vomiting, dizziness, and headaches. There is also a very small chance of spinal fluid leakage, due to dural tear, although the use of the fluoroscope dramatically minimizes this risk. Epidurals are not commonly used for neck pain as the cervical spinal structures are harder to navigate safely. Oral steroids, and NSAIDs provide alternative medication options, along with fish oils, glucosamine, and other alternative pain relief remedies.
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Last Updated: 12/31/2010