Epidural Spinal Injections

Epidural spinal injection is a non-surgical treatment option utilized for relieving back pain. Spine degenerative conditions such as herniated disc, spinal stenosis and many others may induce back pain due to the compression of the associated spinal nerves. This pain or numbness may extend to the other parts of the body such as hips, buttocks, and legs. Doctors start with non-surgical methods to treat back pain and epidural spinal injection is one of these preferences. In cases where the patient finds no relief from non-surgical methods then finally surgery is recommended.

Epidural spinal injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as epidural anesthesia given before child birth to decrease labor pain. Epidural injections are administered into the epidural space of the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5mm wide and is filled with spinal nerve roots, fat and small blood vessels.

Indications

An epidural spinal injection may be employed both for diagnostic and therapeutic reasons, including:

• Medications to determine the specific nerve root involved in the spinal problem (diagnostic purpose)
• Medication for inducing short or long-term relief from pain and inflammation (therapeutic purpose)

It is to be noted that epidural spinal injection is not a curative intervention, rather it’s a treatment tool to reduce the discomfort of the patient so that rehabilitation programs such as physical therapy may be well executed.

Procedure

Pain management in different conditions such as spinal stenosis, disc herniation and arthritis can be done through epidural injection. Different types of physicians such as physiatrists, anesthesiologists, radiologists, neurologists, and surgeons may recommend epidural injections for pain relief.

Usually epidural spinal injection is done on an outpatient basis. The procedure involves the following steps:

• Patient is taken to the pre op area where trained nursing staff makes prepares the patient for the procedure by taking vitals and reviewing medications. Blood sugar and coagulation status may also be checked if needed.
• Patient is taken to the procedure room and will lie face down on a table.
• The injection site is then cleansed and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.
• A thin hollow needle is then inserted into the epidural space, guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.
• A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.
• When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine.
• Finally, the needle is removed and the injection site is covered with a dry, sterile bandage.

Patients may feel some pressure during the injection but mostly the procedure is painless. The procedure takes about 15-30 minutes to complete. After injection, the patient should not drive or go back to work and should rest and avoid any vigorous activities. Your surgeon may give specific post-care instructions. Please follow the instructions to recover faster.

Recovery time

Patients may feel numbness in the arms or legs just after procedure along with other side effects related to the anesthetic component that usually settles down within 1-8 hours. Patients may continue to feel some back pain, as epidural spinal injections take about 24-72 hours before showing their pain-relieving action. In some cases, if the desired effect is not obtained, then reinjection may be recommended. The standard guidelines for steroid injections state a maximum of 3 injections per year. In case no relief is obtained from spinal injection, then surgery is considered as the final option.

Risks and complications

With any procedure some risk factors will always be there. Likewise, epidural spinal injections have complications such as bleeding or infection at the injection site, pain during or after injection, post-injection headache, nerve injury, bladder dysfunction, fluid retention, respiratory arrest, epidural hematoma, and spinal cord infarction. Discuss with your doctor if you have any concerns prior to the procedure.

Scoliosis Treatment

Scoliosis is the abnormal curvature of spine giving the spine an “S” or “C” shape. Scoliosis can occur at any age and is more common in girls than boys. Larger curves cause discomfort while the smaller curves do not cause any problems. In most cases, the exact cause remains unknown.

Scoliosis is categorized into four major types based on the age of onset, cause and spinal curvature. They include:

• Structural Scoliosis
• Non-structural Scoliosis
• Idiopathic Scoliosis
  • Infantile scoliosis
  • Juvenile scoliosis
  • Adolescent scoliosis

Other types include neuromuscular, congenital and degenerative scoliosis.

Based on type of scoliosis, age of the patient, and severity of curvature the surgeons recommend either non-surgical or surgical treatment. Non-surgical treatment includes periodical observation at 4 to 6 months intervals. If the curve is mild and patient has balanced patterns of malformation, it requires no treatment. Doctor will observe these changes by X-rays taken during the period of rapid growth. Braces or casts are used to control the compensatory curves that are adjacent to the congenital abnormality of vertebra to prevent them from worsening.

Surgical options include:

• Spinal fusion – It involves removal of the abnormal vertebra and replacement of vertebrae with bone grafts. Two or more vertebrae are fused together with the help of bone grafts and internal fixators such as metal rods, wires, hooks, or screws are used to form one single bone. These internal fixators help to stabilize the fusion and partially help to straighten the spine. After the surgery, patients must wear a cast or splint to help the healing process.
• Hemivertebra removal – In this procedure, the hemi vertebrae or abnormally shaped vertebrae are removed and the vertebrae present above and below the hemi vertebrae are fused together with the help of metal screws. This procedure helps to straighten the spine and allows the adjacent portion of the spine to grow normally. After the surgery, patients must wear a cast or splint to prevent mobilization and bring about fusion of vertebra.
• Growth rod insertion – Spinal fusion surgery will not be effective in a growing child and may cause impairment of the chest and growth of the lungs. Therefore, before going for surgery, doctors recommend a procedure involving insertion of growth rods. One or two rods will be attached to the spine above and below the curve allowing the spine to grow while correcting the curvature. These rods will be left in place until the child is completely grown after which spinal fusion surgery will be performed.
• Reconstructive osteotomy and instrumentation – This procedure is done if spine deformity in children causes breathing problems, pain and risk to the spinal cord or impairment of the torso shape. In such cases osteotomy is done to remove part of the vertebral column and then followed by insertion of internal fixators such as metal rods, hooks, screws and wires to restore the balance of the spine.
• Physical therapy – Doctors advice physical therapy after the surgery to help the spine grow normally. Physiotherapists evaluate the posture, muscle strength, and flexibility and then design an exercise program suitable for the patient that helps to control pain and improve the disability.