Diagnostic and Therapeutic Selective (Transforaminal) Epidural Spinal Injection
What is the epidural space and why may a selective epidural spinal injection be helpful?
The covering over the nerves in the spine is called the dura. The sleeve-like space surrounding the dura is called the epidural space. Nerves travel through the epidural space and out of the spine through small nerve passageways before traveling into your arms, chest or legs. Inflammation of these nerves from a damaged disc or from contact with a bone spur, may cause pain in your arms, chest or legs.
A selective epidural injection places anti-inflammatory medicine (cortisone) around a spinal nerve and may help reduce inflammation, which can cause or contribute to pain. By stopping or limiting nerve inflammation, the epidural injection may help promote healing.
Although not always helpful, epidural injections reduce pain and improve function in most people within 3-7 days. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.
A selective epidural injection also provides diagnostic information. If the nerve injected becomes numb after the procedure, and that nerve is the reason for your pain, you will feel immediately better. This helps to prove that the nerve we injected is the source of your pain. This helps in guiding future treatment options including any future surgical interventions.
One or more injections?
Performing a repeat injection depends on your response to the prior injection. If you obtain excellent relief from an epidural, you do not need to have it repeated. If you have partial sustained benefit (>35% relief) the epidural can be repeated for possible additive benefit. If an epidural injection provides minimal benefit (<35 % relief), the physician may choose another injection be performed with a change in technique and/or cortisone used.
What will happen to me during the procedure?
- An IV is started and medication to help you relax is administered.
- The skin area is cleansed using an antiseptic.
- Using a temporary local medicine by injection, the physician numbs the skin area where the needle will be inserted.
- Using fluoroscopy (real time x-ray) guidance, the physician inserts and positions the needle.
- To confirm the needle is properly positioned, a small amount of contrast is injected. As the contrast is injected, the doctor can see how the pain relieving medicine spreads into and around the epidural space.
- Once confirmed, the physician injects the anti-inflammatory and pain relieving medication (eg, corticosteroid).
- The injection site is covered with a small bandage or dressing.
What should I expect after the procedure?
You may or may not obtain improvement in the first few hours after the injection.
- Report your remaining pain (if any) and record the relief you experience over the next week in a pain diary (provided by your physician).
- Take your regular medicines after the procedure, but try to limit your pain medicines the first 4-6 hours after the procedure so that the diagnostic information obtained from the procedure is accurate.
- You may notice an increase in your pain lasting for several days. This occurs after the numbing medicine wears off but before the cortisone has a chance to work. Ice will typically be more helpful than heat during this time.
- You may begin to notice an improvement in your pain 1-5 days after the injection. Improvements will generally occur within 10 days after the injection.
On the day of the injection, you should not drive and should avoid any strenuous activities. On the day after the procedure, you may return to your regular activities. When your pain has improved, start your regular exercise/activities in moderation. Even if you are significantly improved, gradually increase your activities over 1-2 weeks to avoid recurrence or your pain.
*SpineUniverse Editorial Comment: Dr. Dreyfuss has provided excellent information for patients who undergo this procedure. Instructions and information provided by your physician may vary.