During an epidural injection a liquid anti-inflammatory (steriod) medication is injected into the epidural space. (The anatomy of the epidural space between tissue layers surrounding the spinal cord is as much a “space” as is the gap between two sheet layers on your bed.)
Inflammation in the epidural space can irritate nerve tissue and cause symptoms commonly referred to as “sciatica” or a “pinched nerve”. Degenerative changes from spine arthritis and spine disc abnormalities are common causes of inflammation in the epidural space.
The use of steriods in the epidural space is a common off label use for this class of medication, however doing so still remains an alternative for patients to consider, especially if their goal is to avoid spine surgery.
Before the procedure starts you will speak with Dr. Terebuh in an exam room to answer any final questions you have. He will also verify procedure safety questions. You will then be escorted to the procedure room where all the necessary equipment is located. The procedure table is a rather narrow padded surface and you will be asked to position yourself on your belly. A procedure room assistant will be present to help you if you desire. Positioning pillows can be used to make you as comfortable as possible. The procedure table will elevate several inches and the targeted area of your spine will be sterilized with an alcohol based skin preparation that gives a cool sensation and temporarily tints your skin orange.
A moving x-ray machine called a fluoroscope operated by Dr. Terebuh will be used to guide the entire procedure. The fluoroscope surrounds you like the letter “C” but it will never touch you. Nerves are “invisible” with x-rays so the fluoroscope is used to see the bone landmarks in the spine and increases the comfort, safety, and precision of the injection. The design of the C-arm fluoroscope allows Dr. Terebuh to get the ideal view angle to perform your procedure. The fluoroscope does deliver a dose of radiation similar to an x-ray and the machine settings are adjusted to administer the absolute minimum radiation dose possible for your procedure.
How to Prepare?
To get ready for your procedure please read the Preparing For Your Spine Injection page of this website.
The epidural space can be accessed by three different approaches: a transforaminal technique, an interlaminar technique, or a caudal technique (shown in videos below). During your preceding office visit to plan the epidural injection procedure, Dr. Terebuh will discuss these alternatives with you and select the technique that is most appropriate for your particular spine situation and general medical circumstance, with the goal of delivering the medication where it will do you the most good. The skin over the targeted landmark will be injected with numbing medicine, which causes a very temporary sensation like a “bee sting”. Most patients agree that the numbing of the skin is the most unpleasant part of the entire procedure (fortunately it is very brief) and the rest of the process feels like movement and pressure rather than pain.
Each needle movement is verified by the fluoroscope to ensure your safety and your comfort. Once the needle tip is in the ideal position relative to the bone landmarks, a small amount of x-ray dye (contrast) is injected. This dye is visible on the fluoroscope and Dr. Terebuh uses it to verify that the flow of the dye goes into the epidural space and to make sure blood vessels are not carrying it away from the target. (If you have an x-ray dye allergy, this verification step with the x-ray dye cannot take place.)
The final step is slowly injecting the treatment medication into the epidural space precisely to the desired location. A bandage will be applied to the injection site and you be escorted back to the original exam room for the after injection observation, monitoring, and discharge process.
Lumbar Transforaminal Epidural Steroid Injection
Cervical Epidural Steroid Injection
Anatomy of the Spine