Spinal injections, also called epidural spinal injections (ESI), are a way for physicians to deliver strong anti-inflammatory medication directly into the area around the sac of fluid surrounding the spinal cord. This area is called the epidural space. Anti-inflammatory medications decrease pain and other symptoms of many spinal conditions and disorders. Epidural spinal injections are not the same as the epidural anesthesia, which is used prior to childbirth or before certain surgical procedures.
Spinal injections are given with the help of X-rays, in a process known as fluoroscopy. Fluoroscopy allows the physician to visualize the spine during the spinal injection to ensure the needle is placed in the correct location. This decreases the risk of complications and helps improve the chance of a positive outcome. Studies have shown that without X-rays to guide needle placement, spinal injections are given in an incorrect area of the spine up to 40% of the time.
Most often, three types of agents can be administered in an epidural spinal injection.
If you have an allergy to contrast dyes or to iodine, seafood, or shellfish, be sure to tell your doctor prior to a spinal injection.
There are two types of spinal injections, diagnostic spinal injections and therapeutic epidural spinal injections.
Diagnostic Epidural Spinal Injections
If a patient is experiencing back pain and/or other symptoms like numbness or tingling in the arms or legs, or muscle weakness, and the reason for the symptoms has not been determined, a spinal injection can help determine the source of the symptoms.
In a diagnostic epidural spinal injection, only a local anesthetic and contrast material are injected into the area most likely to be causing symptoms. It is important that the patient be having typical symptoms at the time of the spinal injection to determine whether the numbing agent is effective, so it is important that patients do not take pain medication prior to this procedure.
If pain is relieved by the diagnostic epidural spinal injection, it can be assumed the site of the injection was the source of pain. If symptoms are not relieved, another site will be chosen and another spinal injection administered. Patients may need more than one diagnostic spinal injection, depending on their response.
These spinal injections are not curative. Pain will return when the anesthesia wears off. This takes about an hour. Once the source of symptoms is determined, a therapeutic epidural spinal injection may be given.
Therapeutic Epidural Spinal Injections
Therapeutic spinal injections contain steroid medications. These are not the kind of steroids used by athletes to build muscles. These are powerful anti-inflammatory medications, and because they decrease inflammation, they reduce pain. Epidural spinal injections typically do not provide immediate pain relief. The effect of the steroid medication may take anywhere from four hours to up to one week to begin.
Therapeutic epidural spinal injections are usually used in combination with other treatments for back pain, such as physical therapy and oral medications. This helps increase the probability of symptom relief.
Therapeutic epidural spinal injections are not successful in relieving symptoms in every case of back pain. When effective, they can provide symptom relief lasting from a few weeks to several months.
Epidural spinal injections are given to help control pain and other symptoms in the legs or arms that are caused by inflammation of the spinal nerves. Typically, epidural spinal injections are only recommended when other less-invasive treatments have been tried unsuccessfully to relieve the symptoms of nerve inflammation.
Spinal nerve inflammation can be due to different conditions, including:
Most of the time epidural spinal injections are given as an outpatient procedure in a clinic or hospital. The procedure typically takes from 30 to 45 minutes. If you have any allergies, or if you are diabetic, you need to be certain your doctor is aware of this before your procedure. Also, make sure your doctor is aware of all medications you are currently taking.
Your doctor may have specific instructions for you to follow to prepare for an epidural spinal injection, so be sure to follow these. Also, ask any questions you may have prior to being scheduled for the spinal injection.
Sometimes patients experience an increase in pain for one or two days following a spinal injection. You can apply a cold pack to the injection site to help with this and the pain should gradually decrease.
Any invasive procedures carry the risk of complications. Potential complications that may result from an epidural spinal injection include:
If you experience any of the following symptoms after an epidural spinal injection, notify your doctor right away: