http://www.medilaw.tv Lumbar Spine Epidural Steroid Injection Block transforaminal attorney videos. This movie illustrates the technique for performing a lumbar transforaminal epidural injection in the prone position. This movie shows patient positioning, skin preparation, local anesthetic injection, needle introduction into the epidural space, contrast injection to check the needle tip position in the epidural space, steroid / anesthetic injection, and finally wound dressing.
An epidural injection is used to inject medication into the epidural space.
Lumbar Spine Epidural Steroid Injection Block transforaminal attorney videos.
The epidural space is the area between the spinal cord sac, or dura, and the inside of the bony spinal canal. It contains fat and small blood vessels. The nerves from the spinal cord travel through the epidural space on the way to the trunk and limbs. An injection into the epidural space will coat the dura, the nerve roots and the adjacent facet joints with the medication.
An epidural injection can be diagnostic, to determine the pain source, or therapeutic, to provide ongoing pain relief. If the injection relieves the pain, then the injection site is the source of the pain. Once the source of the pain is known, treatment options can be considered.
Medications injected include
- lidocaine/lignocaine - a local anesthetic that acts quickly but only lasts thirty to sixty minutes. Often used during diagnostic injections.
- cortisone - a strong long lasting anti-inflammatory. It can take several days to work, but its effect can last for months.
- bupivacaine/marcaine - a slower acting and longer lasting local anesthetic
- morphine or fentanyl - are narcotics that can be added to increase the pain relief
- clonidine - a pain reliever, especially for nerve pain.
- wydnase - to dissolve scar tissue
Epidural injections are used when the nerves are irritated, as by a herniated disc, spinal stenosis, or facet joint degeneration.
The non-surgical alternatives to epidural injection may be
- activity modification
- weight loss
- aerobic exercise, such as walking, cycling, and swimming
- strength and flexibility exercises
- physical therapy
- heat and cold pads
- oral pain-relieving medications such as acetaminophen or paracetamol, non-steroidal anti-inflammatory drugs, glucosamine, chondroitin
The surgical alternatives to epidural injection may be
- pain management injections or ablations
- surgical decompression and possibly fusion
- disc replacement surgery
- oral steroid medication (may not be as effective).
It is your right to delay or refuse the recommended treatment for your condition. However, this delay or refusal may lead to the worsening of your symptoms, such as increased back pain or leg pain, pins and needles, weakness or numbness. You should ask your doctor what might happen should you choose not to undertake the recommended treatment.
Before the epidural injection
- cease blood thinners as instructed ie coumadin/warfarin, plavix, heparin, aspirin
- let your doctor know all the medications you are taking including herbal medications that can increase bleeding risk ie vitamin E, glucosamine, chamomile, danshen, garlic, gingko, devil's claw, ginseng, fish oil, willow bark, feverfew, and goji berries
- you should take your routine medications, but stop any pain relievers or anti-inflammatory medication for the day. You need to have some pain, so you can assess whether the injection gives you any pain relief.
- you will be admitted into the hospital on the day of the procedure
- bring your radiological images and reports ie X-rays, CTs, MRIs
- don't eat or drink for a few hours before the procedure.
- wear loose-fitting clothes that are easy to take off and put on. Do not wear any jewelry.
- before the procedure, the skin on your back will be cleaned and you will be given a general health check.
- an intra-venous line may be placed into a vein in your arm to administer fluid and medications
- let your doctor know if you develop a fever, cold or flu symptoms before your scheduled procedure.
You may be sitting or lying on your side or front. The skin on your back will be cleaned. A small needle will be used to inject some local anesthetic under the skin. This will sting for a few seconds before causing numbness. The epidural needle is inserted through the intervertebral foramen, into the epidural space. Fluoroscopy, an X-Ray TV, is often used to guide the needle into the epidural space. A small amount of local anesthetic is injected. If the needle is correctly positioned, you will feel warmth and numbness in your legs. Then the rest of the medication is injected, the needle is removed and a band aid is applied. The entire process takes 10 to 30 minutes. Lumbar Spine Epidural Steroid Injection Block transforaminal attorney videos.