The pain in the epidural space is one of the less common pain-related problem, but make no mistake, it is still a problem that can happen to anyone. This article will discuss the causes and treatments for it. In this article, we will be discussing what the epidural space is, and how a cervical transforaminal epidural steroid injection can help in treating it.
What is the epidural space?
The dura is a covering that protects the spinal cord and its nerves. The epidural space is the area surrounding the dura. It is known as the cervical epidural space in the neck.
What causes pain in the epidural space?
The cervical region of the spine is made up of seven bones known as vertebrae. Between these vertebrae, soft discs cushion, hold them together, and govern motion. Chemicals inside a disc may leak if it tears. This can induce pain by inflaming nerve roots or the dura. A significant disc tear can cause a disc to expand, causing discomfort by inflaming nerve roots or the dura. Osteophytes, or bone spurs, can also press against nerve roots and create discomfort.
How do I know if I have disc and nerve root pain?
Cervical disc and dural inflammation may cause pain in your neck and upper back when you move your head or neck. If you have pain in your arm when moving your head or neck, you may have nerve root irritation.
What is a transforaminal cervical epidural steroid injection?
A transforaminal cervical epidural steroid injection (TFESI) is an anti-inflammatory drug injection into the epidural space. A transforaminal injection is performed from the side where the nerve exits the spine. It delivers medication to the site of the inflammation.
What happens during a transforaminal cervical epidural steroid injection?
To numb your skin, a local anesthetic will be applied. After that, the doctor will implant a tiny needle directly into the epidural space. To assure the safe and appropriate positioning of the needle, fluoroscopy, a form of moving x-ray, must be employed. A dye may also be used to ensure that the needle is in the right place and that the drug is spreading appropriately.
How do I prepare for the steroid injection?
A cervical transforaminal epidural steroid injection is a small surgical operation that is usually carried out in an ambulatory surgery center. You should not consume any food or drink for at least 2 hours before your treatment. Except for blood thinners, you should take all of your medications on the day of your treatment. If you have any queries about specific drugs, please call our office.
Can I have sedation for the procedure?
The vast majority of patients do not require sedation for the treatment; but, if you desire it, we will administer light sedation (Valium) for the surgery. Patients who are sedated must be accompanied by a responsible adult who will drive them home.
What should I expect during the procedure?
During the process, you will be laying face down on an X-ray table. Pillows may be placed under your chest to assist your surgeon with appropriate alignment. To guarantee adequate positioning, live X-rays (called fluoroscopy) will be taken.
After cleaning your neck with an antiseptic solution, a sterile drape will be draped over it to keep it clean during the process. After that, a local anesthetic will be put into your skin to numb it. The epidural needle will then be placed through the numbed skin and progressively progressed into the epidural space with the use of fluoroscopy (live X-rays).
When the needle enters the epidural area, you may feel a chill or increased pressure in your upper back, neck, and arms. Once the needle is in the epidural area, a small amount of contrast will be given under live X-ray to ensure correct medicine distribution. During this injection, you will feel increasing pressure.
The corticosteroid will then be carefully administered into the epidural space. Again, increasing pressure is fairly usual at this portion of the surgery. If the pressure becomes too uncomfortable, notify your surgeon immediately. When the injection is finished, the needle is removed and a dressing is applied to the injection site.
How soon can I go home after the procedure?
Over the following 15 to 20 minutes, your blood pressure, pulse, and respiration will be monitored periodically. You will be permitted to go home once your vital signs have stabilized.
Can I drive myself or do I need a ride?
Most patients prefer to have a family member or friend drive them to their operation; however, if you are not requesting anesthesia, you may drive yourself.
How long will it take for the pain relief to take effect?
Some patients will notice instant relief; however, it normally takes 24 to 72 hours for the effects of the steroid drug to take effect, and the greatest benefits may take up to a week to reach. Often, more than one injection is required to get adequate pain relief.
Can the procedure make my pain worse?
Some patients will suffer minimal pain during the operation, which will subside quickly. Patients have occasionally reported a protracted increase in discomfort following the surgery. Please contact our office to discuss if this occurs.
What if the procedure does not improve my pain?
Epidural steroid injections treat pain produced by irritated nerves in your neck, but they may not relieve pain caused by spinal and muscular disorders, which can persist after the procedure. To acquire improved pain relief, you may need to continue taking oral drugs or undergo further interventional treatments.
How many injections do I need? How often can I have an injection?
In general, you will receive up to three injections over the course of at least two weeks to provide maximum pain relief. Most patients will enjoy at least 6 months of pain alleviation following the initial series of injections if the injections are successful. If the pain returns, you may return for further injections. Within a six-month period, a maximum of four injections may be performed.
Are there any restrictions following the procedure?
We ask that you refrain from swimming for 24 hours following the steroid injection. This implies you can shower, but not bathe or swim for the remainder of the day. Although there are no other restrictions on activity, we urge that you “take it easy” for the rest of the day and gradually resume your normal activities. Because of the numbing medicine, many patients enjoy a period of painlessness shortly following the injection. It is critical not to overextend yourself with activity during this period.
What are the risks of the procedure?
Overall, epidural steroid injections are extremely safe. Serious adverse effects or consequences from epidural steroid injections are uncommon. However, like with any injection technique, there is the possibility of side effects. The most common consequences are needle puncture bleeding and bruising, post-operation headaches, and lightheadedness or vertigo shortly following the surgery.
Epidural infection, epidural hematoma (bleeding into the epidural space), transitory numbness or weakness, paralysis (partial or full), contrast or allergic responses, and sexual dysfunction are all relatively rare problems. If you feel any worrying symptoms following your injection, contact your doctor immediately or go to the nearest emergency facility for evaluation.
How long can I expect pain relief?
The degree of disc, dural, or nerve root inflammation may influence the intensity and duration of pain alleviation. Other coexisting causes may be to blame for your discomfort. Sometimes an injection provides several weeks to months of pain relief before requiring additional treatment. Occasionally, a single injection provides long-term pain relief. If your pain is caused by an injury to more than one place, a single injection will only relieve some of your symptoms.