WHAT IS THE EPIDURAL SPACE
The Dura is the covering of the spinal cord and its nerves. The area surrounding the dura is the epidural space. In the lower back this space is called the lumbar epidural space.
WHAT CAUSES PAIN IN THE EPIDURAL SPACE
The Lumbar area of the spine has 5 bones called vertebrae. They act as the structural beams that support the spine. Soft DISCS between the vertebrae act as cushions/shock absorbers, as well as in helping control motion. If a disc is injured, it releases chemicals that will induce inflammation of the surrounding area, including adjacent nerve roots. The result is pain, numbness, tingling, and if severe loss of reflexes and strength. If a large tear occurs, a disc may herniate. This means that the soft central pulp of the disc (nucleous pulposus) gets squeezed out, and can mechanically disrupt the course of the nerve root(s). Bone spurs can also cause this mechanical compromise, but develop over a much longer time course.
WHAT IS A LUMBAR EPIDURAL STEROID INJECTION
During the procedure, a local anesthetic (numbing agent) and a corticosteroid (antiinflammatory and pain medication) are injected into the epidural space to reduce inflammation and pain. The doctor may injection from behind the spine, or possibly from the side depending on the nature of the issue/pathology.
WHAT HAPPENS DURING AN INJECTION
Depending on patient and physician request sedation may be utilized. This can be in oral (drinking a liquid) or more powerful form through an IV. Alternatively, no sedation is required. A local anesthetic will be used to numb the skin, and muscles of the back. The physician will then insert a thin needle directly into the epidural space. Fluoroscopy, or live x-ray, is used to expertly place the needle tip. A small amount of dye is then used to confirm epidural placement and proper positioning. This is an Iodine based contrast, and please let your physician know of any potential allergy to iodine. Once the doctor is sure that the needle has been properly placed, the medicinal injectate (most often corticosteroid) is placed into the epidural space to bathe the nerve roots and injured tissues.
WHAT HAPPENS AFTER AN INJECTION
You will be transferred to the post-injection area, and monitored for up to 30 minutes prior to discharge to home. You will be given discharge instructions, both verbal and written, as well as a pain diary/log to keep for follow up discussions. This is an important step that allows us to monitor the treatment regimen, and make the necessary adjustments. You may want to check for pain by moving your back in ways that caused discomfort prior to the injections. Don’t push yourself to hard. You may experience immediate pain relief.