Where is the epidural space?
The epidural space runs all the way from the top of your spine (where it joins the skull) to your coccyx (tailbone). It surrounds the Dura, which is the membrane beyond which lies your Cerebrospinal Fluid (CSF) and Spinal Cord. Nerves travel through the epidural space as they travel from your spinal cord to your body.
Why inject steroids into the epidural space?
Steroids (usually mixed with local anaesthetic) can help treat pain arising from damaged nerves. Nerves can be damaged around the spine, usually due to intervertebral disc disease or degenerative spinal disease. This can produce pain, which we call Radicular Pain or Sciatica. Epidural injections target these nerves as they travel through the epidural space.
Where do you inject?
This depends on where your pain is. The most common Radicular pain involves the nerves traveling into your legs, in which case we would inject either via the Caudal canal (near your Coccyx), or via the Lumbar spine. Sometimes Radicular pain can occur from the neck into the arms, in which case we would inject into the cervical spine.
What should I expect?
Initial pain relief is from the local anaesthetic and will last only a few hours. The steroid component begins to work after a couple of days. Not everyone with Radicular pain will benefit from epidural injections. If you do benefit then you should expect this to last on average about 3 months. This can be repeated.
Will it hurt?
All injections are performed with an anaesthetist present to provide sedation, so the procedure itself is comfortable.
What are the risks?
The needle used is small but may cause a bruise. This can produce discomfort for a few days. The local anaesthetic may block the nerves going to either your arms or legs, causing weakness or numbness. Sometimes you may have difficulty passing urine. This is temporary only. Rarely, the needle may puncture the Dura, causing a small amount of CSF to leak out. This can cause a headache. The hole usually repairs itself within a few days, although occasionally a bloodpatch may be needed. Vary rarely, the spinal cord or major nerves can be permanently damaged, resulting in partial or complete paralysis. This is usually due to bleeding, which is why you must stop blood thinners such as Warfarin or Plavix prior to the injection.
How should I prepare?
Make sure you fully understand the procedure, including the reason it is being performed and the risks associated. Make sure you have an appointment with your Pain Specialist within the next couple of weeks and make a note of what effect the injections have on your pain. There are additional requirements to allow sedation to be safely given. These include having nothing to eat or drink for six hours prior to your procedure and having a responsible adult to look after you for 24 hours following your procedure. In addition you should not drive or make important decisions for the first 24 hours following your procedure. If you take medications for Diabetes or blood-?thinning medications ensure you discuss this with your Pain Specialist to seek further instructions.
Please contact Wesley Pain Management or visit wapm.com.au