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Epidural Injections

These are specialized injections of anesthetic and other medications into the space around the spinal cord, also known as the epidural space, to provide temporary or prolonged relief from pain or inflammation. The epidural space is the outermost part of the spinal canal. Epidural injections are used to reduce nerve pain or pain from a painful disc. Under imaging guidance Dr. Magaziner delivers pain relieving medication directly to the site of injury to provide rapid relief in either the neck, mid, or lower back. Dr. Magaziner is able to do this thru a variety of methods to better target the individual problem. When necessary he can pass a very fine catheter into the spine and steer it to the site of injury for pin point precision.

epidural

Who is an epidural candidate?

Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

    1. Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
    2. Spondylolisthesis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, it can compress the nerve roots causing pain.
    3. Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
    4. Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
    5. Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

Epidural injection can also help determine whether surgery might be beneficial for pain associated with a herniated disc. When symptoms interfere with rehabilitative exercises, epidurals can ease the pain enough so that patients can continue their physical therapy.

Individual results may vary from patient to patient. For more information on Carpal Tunnel Release procedures, please contact our office.

The Procedure

At the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. Commonly, this procedure is performed under general anesthesia however, in some circumstances the patient remains awake under a low dose sedative so they can provide feedback during the injection. The procedure may last 15-45 minutes, followed by a recovery period.
It is our goal to inject the medication in the region of the painful nerves as accurately as possible. The type of injection depends on your condition. The doctor will decide which type is likely to produce the best results. Under x-ray fluoroscopy, the doctor directs a hollow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy allows the doctor to watch the needle in real-time on the x-ray monitor, ensuring that the needle goes to the desired location. Some discomfort occurs, but patients more commonly feel pressure than pain.
When the needle is correctly positioned, the anesthetic and medications are injected into the epidural space around the nerve roots. The needle is then removed. Depending on your pain location, the procedure may be repeated for left and right sides. One or several spinal levels may be injected. In some cases, Dr. Magaziner can perform what is known as a Sweet Epidural which does not use steroids but substitutes a natural solution that is calming to the nerves.

Following Epidural Injection Treatment

Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the center. Rarely temporary leg weakness or numbness can occur; therefore someone should drive you home. Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol).
You may want to record your levels of pain during the next couple of weeks in a diary. You may notice a slight increase in pain, numbness, or weakness as the numbing medicine wears off and before the corticosteroid starts to take effect.
Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.

The Results?

Many patients experience some pain relief benefits. For those who experience only mild pain relief, one to two more injections may be performed, usually in 1-4 week intervals, to achieve full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with conservative care with a chiropractor or physical therapist and/or home exercise program to strengthen the back muscles and prevent future pain episodes.

The Risks

This is considered a safe nonsurgical procedure with few risks. Dr. Magaziner has successfully performed thousands of these procedures. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, and nerve damage / paralysis (rare).
Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work). Patients who are being treated for chronic conditions (e.g., heart disease, diabetes, rheumatoid arthritis) or those who cannot temporarily discontinue anti-clotting medications should consult their personal physician for a risk assessment.

Individual results may vary from patient to patient. For more information on Epidural Injections, please contact our North Brunswick office.

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