ABOUT YOUR ACHING BACK . . .

Not infrequently the nerve roots which leave the spinal canal in the low back region become inflamed and irritated through pressure exerted on them by the bones and tissues of the spine. Conditions which may cause this include injury, arthritis, bone spurs, spinal stenosis, and degenerative disc disease. Often the inflammation of these lumbar nerve roots and subsequent pain can be lessened and even eliminated by the injection of steroids, potent anti-inflammatory drugs, into the epidural space of the spinal canal. This epidural space in located between two layers of tissue covering the spinal cord. All lumbar nerve roots pass through this epidural space and are in a position to absorb directly medications placed into the space.

THE PROCEDURE . . .

To find the epidural space, a physician, usually an anesthesiologist, uses local anesthesia to desensitize an area in the low back at or near the level of the inflamed nerve(s). A blunt-tipped needle is them placed through the anesthetized area into the epidural space next to the nerve(s), and steroids are injected along with a saline solution. The desired result is a decrease in the inflammation of the affected nerves with, hopefully, substantial pain relief. The procedure takes approximately thirty minutes. In most cases there is very little discomfort experienced as the needle is positioned in the epidural space; however, there is a pressure sensation as the needle is placed into the back and often patients experience transient pain similar to their regular nerve root symptoms as the steroid solution is injected into the epidural space.

THE OBJECTIVE . . .

The benefit of epidural steroid injection is the potential for the lessening or elimination of lumbar nerve root pain. Over half the patients who have an epidural steroid injection report 50% to 70% pain relief. Some patients experience 100% relief. However, unfortunately, some patients have no relief at all. The pain relief can last for an undetermined amount of time. Some patients never have pain again, while some have a recurrence days to weeks following their injection. Both the quantity and quality of the pain relief, as well as the duration, are unpredictable. Epidural steroid injection is, however, a reasonable treatment option when conventional therapy such as analgesics, muscle relaxants, bed rest, lumbar exercises, and physical therapy have failed to give relief and when one would like to avoid surgery, if possible.

POTENTIAL PROBLEMS . . .

As with any medical procedure, epidural steroid injection does have the potential for side effects or complications. The most common (occurring about 2% of the time) is spinal tap, which may result in the postponement of the procedure, plus the possibility of headache for the patient. The headache acquired with a spinal tap may range from mild to incapacitating. The primary treatment for this type of headache is bed rest and analgesics. If the headache is severe and persists two or three days, another procedure can be performed, usually eliminating most headaches very rapidly. The more serious, but very rare complications include: temporary or permanent nerve paralysis caused by hitting the nerve with the needle, introducing an infection into the epidural space, or some bleeding which could compromise a lumbar nerve. Serious complications such as these are extremely rare. The reported incidence is about 1 out of 6,000.

SCHEDULING . . .

The physician who referred you for epidural steroid injection will inform the scheduling facility of your age, presumed diagnosis, past spinal history, pertinent laboratory tests (X-rays, CT scans, MRI, etc.), as well as the presumed level of your nerve root problem. Once this information is received, you will be scheduled for your procedure. Generally, you will meet with your anesthesiologist immediately before your procedure. If you desire a pre-operative consultationor have any questions that need to be addressed in advance please call our office at 650-323-0617. One of our anesthesiologists proficient in the procedure will call you to answer your questions.

It is recommended that you do not eat or drink anything for at least four hours prior to your injections. However, medications should be taken as usually prescribed with small sips of water. You must be either knowledgeable about your current medications and allergies, or bring a list of them with you.

AFTER THE INJECTION . . .

You will be expected to have either a ride home following the procedure, or have someone available to give you a ride if it becomes necessary. Most patients will be able to resume normal activities immediately after their injection, but some patients may have increased nerve root pain following the injection. These patients are advised to rest in a comfortable position for a day or so. Continuation of prescribed analgesics remain appropriate as needed for post-injection pain.

Your referring physician remains your primary care provider. Questions about follow-up care, exercise, analgesics, treatment course, etc. should be addressed to him/her. Questions specifically about your epidural steroid injection may be addressed you referring physician or to your anesthesiologist.

Follow-up visits to your referring physician after your injection vary. At a minimum, you should call your referring physician ten to fourteen days following your epidural steroid injection to discuss with him your experience with your block. Usually your anesthesiologist will follow up with you by telephone approximately two weeks following your injection.

All of your physicians hope your lumbar root nerve root pain and disability will resolve without surgery. Epidural steroid injection is one treatment option which may help you obtain this goal.