Cervical: Neck
Epidural: Place where medication is injected (just outside where your spinal nerves are located)
Steroid: Strong anti-inflammatory that is being injected
Interlaminar/Translaminar: Between the lamina or the posterior bony parts of the spine
Frequency: 3-4 times/year based upon your total steroid load. Typically therapeutic but not specifically diagnostic.
Anesthetic: Local
Indications: Pain typically comes from nerves that become irritated and subsequently swollen (inflamed). By placing a steroid, which is a strong Anti-inflammatory, close to the group of nerves that are irritated, this decreases the swelling around these nerves which decreases your pain. This procedure is not very specific in targeting a specific nerve so it is usually used more for pain relief versus actually giving a specific diagnosis for your pain. This is considered a “shotgun” approach to pain relief in your neck and shoulder/arm(s). The patients who typically benefit the most from this procedure have neck pain that radiates down one or both shoulders to the arms. Some patients who complain of shoulder pain may actually have neck pathology causing these symptoms. Some indications include:
- Herniated/bulging discs that are pressing on nerves in your neck
- Acute/Chronic neck pain usually associated with arm pain
- Spinal stenosis
- Continued pain after spinal surgery
- Cervical degenerative disc disease
- Shingles pain in and around your neck/upper back
Contraindications/Reasons why you may not have your injection today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Poorly controlled diabetes
- Certain types of glaucoma
- Poorly controlled bipolar disorder
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Numbness in upper extremities that is short lived
- Infection
- Bleeding
- Allergic reaction
- Cramping in lower extremities
- Mood changes
- Flushed face/extremities
- Headaches
- Worsening of high blood pressure
- Increasing of blood sugars if you have diabetes
- Water retention
- Chronic steroids can cause weight gain
- Seizures
- Stroke
- Nerve and/or spinal cord injury
Procedure:
During the procedure, you will be lying on your stomach. Your arms will be at your sides. An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain. After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. The skin is localized with a local anesthetic, which is usually the most painful part of the procedure as this medicine has a tendency to burn when it is injected. After this point, you should only feel pressure. If anything is too painful for you, please tell your physician as more numbing medicine can be given. When the needle tip is in the epidural space, contrast/dye is injected to confirm this and to make sure the needle is not in a blood vessel and/or in the spinal fluid space. Next, the steroid solution is slowly injected. You may experience increased pressure/warmness in your neck, across your chest and even down the arm(s) that is hurting you which is normal. However, if at any time the pain is too intense, please tell your physician to slow down your injection. After the medication is injected, the needle is removed and the procedure is completed.
Typical length of the procedure:
5 minutes. Expect to be at the clinic no more than 15 minutes after you have been checked in by the medical assistant into the preoperative area. If this is your first time at our clinic, you will likely be at the clinic for at least one hour. Please plan accordingly.
How long do you expect pain relief:
It is difficult to determine how long and how much pain relief you may experience. It varies depending on multiple factors. Some patients do not gain any relief from the procedure and some may have permanent pain relief.
