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.