Preparing For Your Spine Injection

Epidural Steroid Injection

Facet Joint Injection & Medial Branch Block

Radiofrequency Ablation (RFA) Neurotomy

Sacroiliac Joint Injection

 

Stay Hydrated:  Make certain to drink extra water during the 48 hours before your Regenerative procedure.  Being well hydrated significantly helps your body better tolerate any procedure it is experiencing.  

What to Wear:  On the day of your injection please wear very loose fitting and comfortable clothing.  This allows easy access to the targeted area of the spine without requiring you to disrobe.  Loose exercise clothing or lounge clothing is ideal.  Avoid zippers, buttons, belt buckles or draw strings with metal grommet holes because these dense objects block x-ray visualization of your spine.  If your injection is in the neck make sure to leave at home jewelry such as necklaces, ear rings and tongue studs.  Just before the neck injection procedure you will be asked to take of your glasses and any removable dental appliances (bridges, dentures, etc.).  Keep your shoes on during the procedure so you have traction on the tile floor when you stand up after the procedure is complete.

Driver Required: Numbing medicine injected during your spine procedure can slow your foot pedal reaction time even if your legs and feet don’t feel numb.  For that reason you must have a driver bring you home after your injection and you should not drive your vehicle for at least 4 hours after the injection.  This policy is for your safety as well as for the safety of other drivers on the road.  As you make plans for yourself and your driver please schedule one hour total time (from check-in to check-out) which will cover all the steps involved including the after injection observation and monitoring period.

Procedure Related Anxiety and Mild Sedation Options:  If you would benefit from mild sedation in order to go through with your spine injection procedure, a medication can be prescribed to you in advance during the office visit to schedule your procedure.  This prescription should be filled enough in advance so can swallow the tablet at home two hours before the scheduled time of your procedure.  If any type of sedation is used during your procedure then you should not drive until the following day after you have had a full night sleep.  An additional option to make you more comfortable is the use of Nitrous Oxide “laughing gas” during your procedure. 

Injection Safety & Risk Management:  When you and Dr. Terebuh decide to move forward with plans to perform a spine injection procedure, he will ask a detailed series of questions with your safety in mind.  The risk of any medical procedure is never 0% but working together with Dr. Terebuh you can reduce the risk as low as possible.  Each category of safety is discussed below:

Blood Thinners:  There are many over-the-counter and prescription medications that are designed specifically to thin your blood and there are many others that thin your blood as a side effect.  All of these medications make spine injections more risky because they cause you to bleed onto nerves in and around the spine after the injection needle is removed.  When planning your injection procedure Dr. Terebuh will go through a long list of these medications to make the injection as safe as possible by minimizing your bleeding risk.  You can help by reviewing these lists beforehand and notify Dr. Terebuh if you are taking any of these over-the-counter or prescription medications:

Aspirin containing medications thin the blood up to 7 days:

  • Aspirin (ASA – acetyl salicylic acid)
  • Adprin 
  • Aggrenox
  • Alka-Seltzer
  • Anacin
  • Ascriptin
  • Aspergum
  • Bayer
  • Bayer Back & Body
  • Bufferin
  • Doan’s Pills
  • Easpirin
  • Ecotrin
  • Endodan
  • Equagesic
  • Excedrin
  • Fiorinal
  • Fortabs
  • Gelpirin
  • Genacote
  • Goody’s Extra Strength
  • Halfprin
  • Magnaprin
  • Norwich
  • Norgesic
  • Orphengesic
  • PC-CAP
  • Percodan
  • Robaxisal
  • Roxiprin
  • St. Joseph’s
  • Supac
  • Sureprin
  • Synalgos-DC
  • Soma-compound
  • Talwin-compound
  • Vanquish
  • ZORprin
  • Willow Bark Extract

Prescription Blood Thinners all work differently and for different lengths of time:

Generic name in bold and (trade name in parentheses)

  • apixaban (Eliquis)
  • betrixaban (Bevyxxa)
  • cilostazol (Pletal)
  • clopidogrel (Plavix)
  • dabigatran (Pradaxa)
  • dalteparin (Fragmin)
  • danaparoid (Orgaran)
  • dipyridamole (Persantine)
  • edoxaban (savaysa)
  • enoxaparin (Lovenox)
  • fondaparinux (Arixtra)
  • heparin 
  • low molecular weight heparin (Lovenox)
  • pentosan polysulfate sodium (Elmiron)
  • pentoxifylline (Trental)
  • prasugrel (Effient)
  • rivaroxaban (Xarelto)
  • ticagrelor (Brilinta)
  • ticlopidine (Ticlid)
  • tinzaparin (Innohep)
  • warfarin (Coumadin)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) each thin the blood for different durations:  some as short as 24 hours and others as long as 10 days.  To plan appropriately Dr. Terebuh needs to know which of these prescription or over-the-counter NSAIDs you take regularly, occasionally, or even rarely.

Generic name in bold and (trade name in parentheses)

  • diclofenac (Arthrotec, Cataflam, Flector, Voltaren, Zipsor, Zorvolex)
  • diflunisal (Dolobid)
  • etodolac (Lodine)
  • fenoprofen (Nalfon)
  • flubiprofen (Ansaid)
  • ibuprofen (Advil, Combunox, Dolgesic, Duexis, Genpril, Halpran, Medipren, Motrin, Nuprin, Pamprin, Q-Profen, Rufen, Trendar, Tab-Profen, Vicoprofen)
  • indomethacin (Indo-Lemmon, Indocin, Indomethagan)
  • ketoprofen (Actron, Orudis, Oruvail)
  • ketorolac (Toradol)
  • meclofenamate (Meclomen)
  • mefenamic acid (Ponstel)
  • meloxicam (Mobic)
  • nabumetone (Relafen)
  • naproxen (Aleve, Anaprox, Naprapac, Naprelan, Naprosyn, Naproxyn, Vimovo)
  • oxaprozin (Daypro)
  • phenylbutazone (Cotylbutazone)
  • piroxicam (Feldene)
  • salsalate (Disalcid , Trilisate)
  • sulfasalazine (Azulfidine)
  • sulindac (Clinoril)
  • tolmetin (Tolectin)

Supplements can thin the blood for varying lengths of time:

Fish Oil, Garlic, Ginkgo Biloba, Ginseng, Willow Bark Extract

Blood Clotting Disorders:  Notify Dr. Terebuh if you have a blood clotting disorders hemophilia, low platelets, etc. to avoid bleeding complications from the spine injection.

Infection:  You should not get a spine injection if you have an infection anywhere in your body – even a cold or flu!  Whether or not you are taking antibiotics there is a chance of moving that infection into your central nervous system causing meningitis.  Make sure to tell Dr. Terebuh if you have had a recent infection – even if you are taking antibiotics and no longer feeling the symptoms of the infection.

Recent Dental Work:  Bacteria can enter your bloodstream during routine dental cleaning even if you have healthy teeth and gums.  Make sure that you notify Dr. Terebuh if you have had any dental work in the 2 weeks prior to your scheduled spine injection procedure to avoid infection complications in the central nervous system such as meningitis. 

Dye Allergy:  Notify Dr. Terebuh if you have an allergy to or x-ray dye (contrast).  It is possible to perform spine injections without x-ray dye (contrast).

Pregnancy:  Notify Dr. Terebuh if you are or could possibly be pregnant because your fetus should not be exposed to x-rays from the fluoroscope.

Prior Steroid Treatment:  Steroids are very helpful medications for the treatment of conditions that involve inflammation.  As much good as they do, however, steroids can also cause many health problems if used frequently or in large doses.  Notify Dr. Terebuh how many times you have been treated with steroid in the past 12 months.  Large steroid doses can be given in pill form or injected in muscles, joints or veins.  Steroids also go by many names:  cortisone, prednisone, Medrol, corticosteroids, Kenalog, DepoMedrol, Celestone, Dexamethasone, etc.

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