Lumbar, Dorsal, Caudal and Cervical Epidurals
An epidural injection (commonly referred to as an epidural) is an injection made in the epidural area near the nerve roots in the spine. A combination of anti-inflammatory (cortisone) and anaesthetic (Xylocaine) agents are used during the injection to reduce pain caused by the inflammation of nerve roots.
In simpler terms, the purpose of an epidural injection is to reduce inflammation and pain caused by one or more nerve roots located inside the spine. This procedure is the most precise method to administer anti-inflammatory agents specifically to an area with inflammation likely to be caused by a herniated disc, foraminal stenosis or spinal stenosis.
Clinique de physiatrie et de médecine du sport de Montréal specializes in epidural treatment. Our physiatrists are on hand to guide you and identify the best method of treatment to suit your needs.
Epidural injections are indicated to treat pain in a limb (upper or lower) caused by a nerve root. They are recommended for patients suffering from pain along the sciatic nerve or brachialgia.
Epidural injections are a widespread practice used to treat afflictions of the lumbar spine, commonly known as lombosciatica. The purpose is to inject a minimum quantity of anti-inflammatory (cortisone) to reduce inflammation between a nerve and an intervertebral disc.
In most cases, epidurals provide significant relief from pain caused by irritation or compression of nerve roots. The duration of relief is variable: temporary or permanent, depending on the underlying condition. Effectiveness is not immediate, but usually occurs after a few days. Owing to their effectiveness, epidurals may only be repeated two to three times a year.
Prior to any procedure, patients complete a medical record to clearly indicate the site and path of their pain. Then they are interviewed and examined by a physiatrist before proceeding with an injection.
Patients are settled comfortably on their stomach with the help of a radiology technologist. After carefully disinfecting the skin, a local anesthetic is applied to the skin if needed to ensure greater comfort.
The epidural procedure is performed under fluoroscopic control: a very small quantity of colorant (iodine) is injected to ensure the safe, accurate positioning of an injection needle. A solution containing anti-inflammatory (cortisone – with or without local anesthetic) is then injected. The needle is removed slowly and patients are taken to an observation room for about twenty minutes to make sure that there are no allergic reactions to the injected product.
Based on the clinical presentation and imaging results, the physiatrist may make either of the two following types of epidurals :
- Caudal epidural: The injection needle is inserted into the sacrococcygeal hiatus (a small gap between the sacrum and coccyx).
- Neuroforaminal epidural: The injection needle is inserted into the neuroforamen (intervertebral foramen), located at the exit of the spinal nerve root next to the intervertebral disc.
In general, patients tolerate the technique rather well, despite feeling a slight amount of pain during the injection.
After an epidural injection, pain may increase slightly during the first seven to ten days. If this is the case, applying ice and taking a simple analgesic such as acetaminophen (Tylenol) usually helps to ease discomfort and provide some relief.
Le cycle menstruel des femmes peut parfois être perturbé temporairement après l’intervention.
Some redness and a warm sensation may occur on the face. This reaction is only a side effect and not the sign of an allergic reaction. It should pass in the days following the procedure.
Women’s menstrual cycle may sometimes be disrupted temporarily following the procedure.
For patients with diabetes, glycemia may increase for a period between 48 to 72 hours, after which it should return to the usual blood sugar levels. It is very important for patients to notify their physicians prior to the procedure if glycemia is above 10.
Generally speaking, complications following an epidural injection are extremely rare. Radiology devices at the cutting edge of technology and our physiatrists’ standards of practice are instrumental to lowering risks of complications at our clinic in Montréal.
However, there is always a very slight risk of infection during injections. If you are taking antibiotics for an infection or if you have fever, you should notify your physician prior to the procedure to minimize any related risks.
During injections, there is also a slight risk of bleeding complications. If you are taking blood thinning medication (anticoagulant or antiplatelet agents), it would also be advisable to notify your physician prior to the procedure.
To reduce risks of complications, certain precautions are advised :
- If you are taking antibiotics for an ongoing infection, you must inform your physician. You will probably be advised to end treatment for your infection before undergoing epidural injection.
- During pregnancy, injections under fluoroscopic guidance like epidurals are contra-indicated.
- Prior to any procedure, please inform our staff of any allergies to medication or contrast products like iodine.
- For some injections, patients must stop taking anticoagulants (Coumadin) and antiplatelets (Plavix) before the procedure; patients must obtain an authorization from their prescribing physician to stop the medication temporarily.