Cervical, Thoracic, Lumbosacral
Selective Epidural Injection
What is the epidural space and why is a selective epidural helpful?
The covering over the nerve roots in the spine is called the dura.
The space surrounding this dura is the epidural space. Nerves travel
through the epidural space before leaving the spine and traveling down
your arms, along your ribs and into your legs. The nerves leave the
spine from small nerve holes. Inflammation of these nerve roots may
cause pain in your arms, chest or legs. These nerve roots may become
inflamed due to irritation from a damaged disc or from contact with
a bone spur. A selective epidural injection places anti-inflammatory
medicine over the nerve root and into the epidural space to stop inflammation
of the nerve roots, therefore hopefully reducing arm or chest wall or
leg pain. The epidural injection may promote healing and speed up "mother
nature". Although not always helpful it reduces pain and improves function
in the majority within 3-7 days. It may provide permanent relief or
provide a period of pain relief that will allow other treatments like
physical therapy to be more effective. We hope it will reduce your pain
during the next several months while the injury/cause of your pain is
healing. A selective epidural is also helpful for diagnostic reasons.
If the nerve is numb after the procedure and the nerve is the reason
for your pain you will feel immediately better and prove that nerve
is your pain source.
What will happen to me during the procedure?
First an IV is started so that you may be given medicine for relaxation
if you so desire. Next, while lying on an x-ray table your skin will
be well cleaned. The physician will numb a small area of skin which
may sting for a few seconds. Next, the physician will use x-ray guidance
to direct a small needle above the nerve root as it leaves the boney
nerve hole. He will then inject contrast dye to confirm that the medicine
spreads to the affected nerve root(s) in the epidural space. After this,
the physician will inject a combination of numbing medicine and time
release anti-inflammatory cortisone.
What should I do after the procedure?
You will wait 30-45 minutes in recovery before going home. No driving
for eight hours. You may have temporary numbness or weakness in your
arm or leg for several hours after the procedure. Please record your
pain relief during the next week on a "pain diary" we will provide to
you. Mail the completed pain diary back to Tyler Neurological Associates.
If you experience complete. or more than 90% relief, of your pain the
procedure should not be repeated. If you experience partial relief it
may be beneficial to repeat the procedure in about two weeks. If you
experience no relief, notify the office and the procedure will probably
not be repeated. We perform a maximum of three epidurals each 2 weeks
apart.
General Pre/Post Instructions
You should eat a light, but not a full meal at least 2 hours before
the procedure. If you are an insulin dependent diabetic do not alter
your normal food intake. Take your routine medications before the procedure
(such as high blood pressure and diabetes medications). Stop aspirin
and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve,
Relafen, Daypro) 3 days before the procedure. These medicines may be
re-started the day after the procedure. You may take your regular pain
medicine as needed before/after the procedure. If you are on coumadin,
heparin, lovenex, plavix or ticlid you must notify my office so that
the timing of stopping these medications can be explained. If you are
on antibiotics please notify our office, we may wait to do the procedure.
If you have an active infection or fever we will not do the procedure.
You will be in the hospital as an out-patient for 2-3 hours even though
you see the physician for 20 minutes. You will need to bring a driver
with you. You may return to your current level of activities the next
day including return to work.
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