PAIN MANAGEMENT

Epidural Steroid Injections

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The spinal cord runs within the bony structure of the vertebral column and is encased by a membranous sac called the dural sac. This sac contains spinal fluid that bathes and nourishes the spinal cord. The epidural space is the space between the outer surface of the dural sac and the bones of the vertebral column.

Nerves from the lower limbs (including the sciatic nerve) enter the vertebral column and pierce the dural sac to reach the spinal cord. For various reasons, these nerves can become irritated as they enter the vertebral column and cause pain in the legs. This pain is felt as shooting down the lower limb and is referred to as nerve pain or technically, radicular pain (from the Latin radix, a root.) The common name for this sort of pain is Sciatica.

The term "Spinal Cortisone Injection" refers to the injection of corticosteroids into the epidural space of the vertebral column as a means of treating pain caused by irritation of the spinal nerves.

How Does a Fluoroscopic Spinal Cortisone Injection Work?
There are diagnostic and theraputic ways in which a Fluoroscopic Spinal Cortisone Injection helps:

1. The first is that some leg pain involves the inflamation of one or more of the nerves, their covering, or their roots, in the back. The injection of steroids directly into that part of the spinal column called the epidural space is thought to aid in reducing inflamation.
2. The second benefit is that the anesthetic/cortisone solution blocks the pain long enough to allow the body to begin the process of repairing itself.
3. The last benefit involves the accurate diagnostic information provided by the nerve block when it relieves your pain.

How is a Fluoroscopic Guided Injection Administered?
You will be asked to position yourself on an x-ray table so that the vertebrae of your back are as widely spaced as possible. A local anesthetic will be injected into the skin and the underlying tissues to decrease the discomfort of introducing the epidural needle.

Once the local anesthetic is working, the epidural needle is advanced into the epidural space, using the bones as landmarks and an x-ray machine (fluoroscope) to ensure that the needle is in the right place.

When the needle is in the epidural space, a syringe containing the corticosteroid solution is connected to the needle. After making sure that the needle is not in a blood vessel or in the spinal fluid, the doctor injects the solution slowly.

The corticosteroid will be injected in a form that may include a saline solution and/or a local anesthetic, however, the dosage and volume of the steroid components will vary according to the individual doctor's judgement

What are the Typical Risks of a Fluoroscopic Spinal Cortisone Injection?
With any operation or injection procedure, there are risks. In the case of fluoroscopic spinal cortisone injections these risks are small.

The most common side effect is temporary increase in pain. It occurs in about 1% of epidural steroid injections. Headaches can also occur, also with an incidence of 1%. If you are allergic to one of the additives in the steroid solution, you may experience hot flush or develop a rash. As with any injection through the skin, it is always possible for bacteria to gain entry, causing an infection. The risk of this with an epidural injection is very small.

It is also theoretically possible that the nerve could be temporarily irritated in the procedure.

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