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Cervical
epidural steroid injections In
this procedure normal saline and a steroid solution are mixed and injected into
the cervical epidural space. The
epidural space is a space surrounding the spinal cord membranes within the bony
spinal canal. Of course the
cervical epidural space is this section of epidural space that is located in the
neck area of the spine. This is
from base of the skull to the level of the shoulders.
This injection is not a spinal block, which is the procedure where local
anesthetic is placed within the spinal membranes containing the fluid, cerebral
spinal fluid that surrounds the spinal cord.
The spinal injection is an anesthetic technique that is done in the
lumbar spine or the back section of the spine do produce anesthesia in the
abdomen and lower extremities for surgical procedures as done in an operating
room. Injection into the epidural space is generally performed by a
physician who is trained in spinal injections and procedures.
This is generally an anesthesiologist who has interventional pain
medicine training as well. The solution injected as mentioned above, is a special
steroid, which is microencapsulated. That
is the compound steroid is surrounded by a compound that makes the molecules of
the steroid lasts longer in the epidural space for longer effect.
In other words the body will have a more difficult time removing or
clearing this material from the epidural space.
In contrast when a steroid injection is made into a muscle such as the
hip or buttock, the molecules of the steroid are not microencapsulated and thus
are cleared by the body faster to be distributed all over the body for a
generalized effect. In this spinal
injection the goal of the injection is effect only in the area injected such as
the cervical epidural space. The steroid injected into the body generally is a very potent
anti-inflammatory drug. The body makes its own steroids naturally as these
compounds are hormones and necessary for life.
One of the well-known naturally occurring steroids of the body is
cortisone. The injected steroids
are more potent and active than the body's cortisone. Therefore the injected steroid in the cervical epidural space
will produce more potent anti-inflammatory response once injected in this space.
Occasionally a very small amount of local anesthetic such as lidocaine is
also injected with the mixture. This
is to reduce abnormality of the function of the nerves in the spinal canal.
Once the mixture of the steroid and local anesthetic in saline is
injected in the epidural space, the solution disperses itself in this space to
surround the spinal nerve roots, capsules of the spinal joints (known as the
facet joints), spinal ligaments and coverings of the bones of the spine
(vertebral elements) and the spinal cord coverings known as dural membranes.
As mentioned reduction of the inflammatory changes of these structures
reduces pain, reflex spasm of the muscles of the neck, reduce inflammation of
the joints and of course the spinal nerves. This injection may be performed in
the office setting or done in the ambulatory outpatient setting.
This specialist performing this procedure may use x-ray control to do
this procedure. This procedure can
easily be done without x-ray control as well.
X-ray control is known as fluoroscopic guidance or fluoroscopy. This
procedure may be done in the sitting, supine or with the patient on his or her
side. The patient may or may not be given sedative medication before procedure.
This is generally determined by the physician who performs the procedure
after assessing the patient and the patient's ability to tolerate the procedure
with or without medication. The
skin and the tissues below the skin are localized with a local anesthetic
injection prior to placement of the needle into the epidural space. The interventional
pain specialist after evaluation may recommend this procedure which then can
be performed. These injections are
done in a series. Usually 1
injection is done every 2 weeks for a total of 3 to 4 injections.
It is possible that the interventional pain specialist may not
recommend a second injection after the first injection be done because of
inadequate response. If this is the
case, other procedures or treatments will be recommended which will be more
beneficial for the particular condition. Sometimes
a second injection is done despite less than adequate response after the first
injection. This is done because the
first injection will produce a certain amount of anti-inflammatory response and
a second injection will allow the solution to spread more in the epidural space
at produce further anti-inflammatory response.
In any event your interventional pain anesthesiologist/specialist
who is trained in the determination of responses after these procedures can make
that determination. It
is important to note that an epidural injection is not a targeted injection.
This means that when a needle is placed into the epidural space, the
fluid injected will take the path of least resistance. Therefore in the areas of
inflammatory change that is sometimes accompanied by viscoelastic adhesions
because of inflammatory changes, may not allow the solution to seep into the
correct area. The solution injected
may go to another place in the epidural space that may not be as inflamed and
thus inadequate response may be obtained after the injection.
In this situation your interventional pain anesthesiologist will
determine other targeted injections, which will ensure placement of this
material into the correct place so that it may do the most good. There
are complications and side effects associated with this injection that are
infection and bleeding which is common to any procedure where the body is
invaded with a sharp instrument. In
this case a needle is used. If the
dural membrane that is the sac that the spinal cord is within with its cerebral
spinal fluid is punctured then there is a risk of postural headache.
In this situation when the patient gets in the sitting or standing
position, a headache will develop which can be mild to severe.
This is not a serious complication however it can be incapacitating to an
individual. This will eventually
stop with at any treatment at all. However
in severe cases where the patient is incapacitated and in severe pain, a blood
patch can be done which generally will immediately resolve the headache.
Finally there are risks of spinal nerve and spinal cord injury that are
very very rare. These complications
generally do not occur in hands of experienced practitioners.
It is important for the performing physician to be well experienced in
the procedure as development of these complications is not as important as there
appropriate treatment as soon as they occur. Dr.
Daneshfar is an interventional pain management specialist and performs many of
these procedures routinely and daily at the Acute and Chronic Pain and Spine
Center (ACPSC) and the local hospitals. Lumbar
epidural steroid injections In
this procedure normal saline and a steroid solution are mixed and injected into
the lumbar epidural space. The
epidural space is a space surrounding the spinal cord membranes within the bony
spinal canal. Of course the lumbar
epidural space is this section of epidural space which is located in the back
area of the spine. This is from the
mid back to the tailbone. This
injection is not a spinal block that is the procedure where local anesthetic is
placed within the spinal membranes containing the fluid, cerebral spinal fluid
that surrounds the spinal cord. The
spinal injection is an anesthetic technique that is done in the lumbar spine or
the back section of the spine do produce anesthesia in the abdomen and lower
extremities for surgical procedures as done in an operating room. A physician who is trained in spinal injections and
procedures generally performs injection into the epidural space.
This is generally an anesthesiologist who has interventional pain
medicine training as well. The
solution injected as mentioned above, is a special steroid that is
microencapsulated. That is the
compound steroid is surrounded by a compound, which makes the molecules of the
steroid lasts longer in the epidural space for longer effect. In other words the body will have a more difficult time
removing or clearing this material from the epidural space. In contrast when a steroid injection is made into a muscle
such as the hip or buttock, the molecules of the steroid are not
microencapsulated and thus are cleared by the body faster to be distributed all
over the body for a generalized effect. In
this spinal injection the goal of the injection is effect only in the area
injected such as the cervical epidural space.
The steroid injected into the body generally is a very potent
anti-inflammatory drug. The body makes its own steroids naturally as these
compounds are hormones and necessary for life.
One of the well-known naturally occurring steroids of the body is
cortisone. The injected steroids
are more potent and active than the body's cortisone.
Therefore the injected steroid in the cervical epidural space will
produce more potent anti-inflammatory response once injected in this space.
Occasionally a very small amount of local anesthetic such as lidocaine is
also injected with the mixture. This
is to reduce abnormality of the function of the nerves in the spinal canal.
Once the mixture of the steroid and local anesthetic in saline is
injected in the epidural space, the solution disperses itself in this space to
surround the spinal nerve roots, capsules of the spinal joints (known as the
facet joints), spinal ligaments and coverings of the bones of the spine
(vertebral elements) and the spinal cord coverings known as dural membranes.
As mentioned reduction of the inflammatory changes of these structures
reduces pain, reflex spasm of the muscles of the neck, reduce inflammation of
the joints and of course the spinal nerves. This injection may be performed in
the office setting or done in the ambulatory outpatient setting.
This specialist performing this procedure may use x-ray control to do
this procedure. This procedure can
easily be done without x-ray control as well.
X-ray control is known as fluoroscopic guidance or fluoroscopy. This
procedure may be done in the sitting, supine or with the patient on his or her
side. The patient may or may not be given sedative medication before procedure.
This is generally determined by the physician who performs the procedure
after assessing the patient and the patient's ability to tolerate the procedure
with or without medication. The skin and the tissues below the skin are
localized with a local anesthetic injection prior to placement of the needle
into the epidural space. The interventional
pain specialist after evaluation may recommend this procedure which then can
be performed. These injections are
done in a series. Usually 1
injection is done every 2 weeks for a total of 3 to 4 injections.
It is possible that the interventional pain specialist may not
recommend a second injection after the first injection be done because of
inadequate response. If this is the
case, other procedures or treatments will be recommended which will be more
beneficial for the particular condition. Sometimes
a second injection is done despite less than adequate response after the first
injection. This is done because the
first injection will produce a certain amount of anti-inflammatory response and
a second injection will allow the solution to spread more in the epidural space
at produce further anti-inflammatory response.
In any event your interventional pain anesthesiologist/specialist
who is trained in the determination of responses after these procedures can make
that determination. It
is important to note that an epidural injection is not a targeted injection.
This means that when a needle is placed into the epidural space, the
fluid injected will take the path of least resistance. Therefore in the areas of
inflammatory change that is sometimes accompanied by viscoelastic adhesions
because of inflammatory changes, may not allow the solution to seep into the
correct area. The solution injected
may go to another place in the epidural space that may not be as inflamed and
thus inadequate response may be obtained after the injection.
In this situation your interventional pain anesthesiologist will
determine other targeted injections that will ensure placement of this material
into the correct place so that it may do the most good. There
are complications and side effects associated with this injection that are
infection and bleeding which is common to any procedure where the body is
invaded with a sharp instrument. In
this case a needle is used. If the
dual membrane that is the sac that the spinal cord is within with its cerebral
spinal fluid is punctured then there is a risk of postural headache.
In this situation when the patient gets in the sitting or standing
position, a headache will develop which can be mild to severe. This is not a serious complication however it can be
incapacitating to an individual. This
will eventually stop with at any treatment at all. However in severe cases where the patient is incapacitated
and in severe pain, a blood patch can be done which generally will immediately
resolve the headache. Finally there
are risks of spinal nerve and spinal cord injury, which are very very rare.
These complications generally do not occur in hands of experienced
practitioners. It is important for
the performing physician to be well experienced in the procedure as development
of these complications is not as important as there appropriate treatment as soon as they
occur. Dr.
Daneshfar is an interventional pain management specialist and performs many of
these procedures routinely and daily at the Acute and Chronic Pain and Spine
Center (ACPSC) and the local hospitals. Caudal
epidural steroid injections This
injection is similar to the lumbar epidural steroid injections with the
exception of needle entry site. In
the caudal epidural steroid injection the needle is placed through a small
opening in the caudal canal at the base of the spinal canal just above the
tailbone. Local anesthetic is given
into the skin and the tissues below the skin to reduce the pain of needle
entering into the caudal canal. Please
refer to the section lumbar epidural steroid injections for full details
regarding this injection, which is similar to the lumbar epidural steroid
injections. Dr.
Daneshfar is an interventional pain management specialist and performs many of
these procedures routinely and daily at the Acute and Chronic Pain and Spine
Center (ACPSC) and the local hospitals. Thoracic
epidural steroid injection This
injection is similar to the cervical epidural steroid injections with exception
of the needle entry site. In the
thoracic epidural steroid injection the needle is placed in the thoracic or the
chest section of the spine. Please
refer to the resection cervical epidural steroid injection for full details
regarding this injection, which is similar to the cervical epidural steroid
injections. Dr.
Daneshfar is an interventional pain management specialist and performs many of
these procedures routinely and daily at the Acute and Chronic Pain and Spine
Center (ACPSC) and the local hospitals.
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