Spinal Injectons and Pre and Post Operative Advice to Consider

Definition

Epidural Spinal Injections

What is a spinal injection?

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.

What drugs are given in a spinal injection?

Most often, three types of agents can be administered in an epidural spinal injection.

  • Local anesthetics: These agents are given to make the area lose feeling or become numb.
  • Contrast dyes or agents: These substances outline the spinal structures, or make them more clearly visible on imaging studies.
  • Corticosteroids: These medications are powerful anti-inflammatory agents.

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.

Different types of spinal injections

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.

Reasons for Epidural Spinal Injections

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:

  • Spinal stenosis: This is an abnormal narrowing of the spinal canal. The spinal canal is the tunnel through which the spinal cord and its nerves travel. When there is not enough space in this tunnel, nerves can be compressed or pinched, and become inflamed.
  • Herniated spinal discs: When intervertebral discs rupture or bulge, they can compress or pinch spinal nerves. Patients with disc problems are most likely to benefit from epidural spinal injections.

What happens during an Epidural Spinal Injection?

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.

  • What to wear: When you arrive at the hospital or clinic, you will change into a gown, so wear clothing that is easy to remove and put back on after the spinal injection.
  • Sedation and anesthesia: In most cases, patients receive a local anesthetic before an epidural spinal injection but sometimes mild sedation can be given. You will be awake during the procedure.
  • Positioning: You will lie on the X-ray table in a position that allows your doctor to access your spine, facing either down or to your side. The area of your back where the spinal injection is to be given will be cleaned and numbing medication may be injected into the skin.
  • X-ray guided injection: Your doctor will insert a needle into your spine, using an X-ray to help guide placement of the needle. When the position of the needle is correct and is confirmed by the injection of contrast dye, the medication will be injected. You may feel pressure during the injection. Epidural spinal injections are not usually painful. It is important to lie quietly without moving during the procedure, because needle placement is very precise.
  • Following the procedure: After the epidural spinal injection, you will be assisted off the X-ray table and allowed to change into your own clothing. If you have been given sedating medication, you will not be allowed to drive, so arrange for transportation home following the procedure. You should plan to rest the remainder of the day. Most patients can resume their normal activities 24 hours after an epidural 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.

Possible Complications related to Epidural Spinal Injections

Any invasive procedures carry the risk of complications. Potential complications that may result from an epidural spinal injection include:

  • An allergic reaction
  • Excessive bleeding
  • Infection
  • Steroid flush
  • Dizziness
  • Nerve damage
  • Necrosis of bone tissue
  • Headache
  • Seizures
  • Cardiovascular collapse
  • Stroke
  • Meningitis
  • Sexual dysfunction
  • Loss of bowel or bladder control
  • Paralysis
  • Fainting
  • Death

If you experience any of the following symptoms after an epidural spinal injection, notify your doctor right away:

  • Severe pain
  • A fever of 100 degrees or above
  • Loss of bladder or bowel control
  • Inability to feel or move your arms or legs
  • A headache when you sit or stand up that is not relieved by lying down
Image of a spinal injection needles being held by a doctor.