What is the epidural space?
The covering over the nerve roots in the spine is called the dura. The space surrounding this dura is called the epidural space. Nerves travel through the epidural space before they travel down into your legs. The nerves leave the spine from small nerve holes. Inflammation of these nerve roots may cause pain in your hip, buttock and legs. These nerve roots may become inflamed due to irritation from a damaged disc or from contact with a bone spur.
What is a lumbar epidural injection and why is it helpful?
A caudal epidural injection places anti-inflammatory medicine into the epidural space to stop nerve root inflammation, therefore hopefully reducing hip, buttock and leg pain. This is more commonly used in those with previous back surgery to avoid the scar tissue at the surgical levels. By stopping or limiting nerve root inflammation we may be able to reduce your pain. The epidural injection may assist the injury to heal by reducing inflammation. Although not always helpful it usually reduces pain and improves in the majority within 3-7 days. It may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective. We hope it will reduce your pain during the next several months while the injury/cause of your pain is healing.
What will happen to me during the procedure?
First an IV is started so that you may be given medicine for relaxation if you so desire. Next, while lying on an x-ray table your skin will be well cleaned. The physician will numb a small area of skin just above the crease in between your buttocks which may sting for a few seconds. Next, the physician will use x-ray guidance to direct a small needle into the epidural space through the tiny bone opening (sacral hiatus) just above the crease in between your buttocks. He will then inject contrast dye to confirm that the medicine spreads to the affected nerve root(s) in the epidural space. If the medicine does not travel high enough to reach the affected nerve root(s) the physician may use a small catheter to reach the target epidural space. After this, the physician will inject a combination of numbing medicine and time release anti-inflammatory cortisone.
What should I do after the procedure?
You will wait 30-60 minutes in recovery before going home. You should not drive for eight hours following this procedure. Please record your pain relief during the next week on a “pain diary” we will provide to you. Mail the completed pain diary back to Tyler Neurological Associates. If you experience complete or more than 90% relief of your pain the procedure should not be repeated. If you experience partial relief it may be beneficial to repeat the procedure in about two weeks. If you experience no relief, notify the office and the procedure will probably not be repeated. We perform a maximum of three injections each 2 weeks apart.
General Pre/Post Instructions
You should eat a light, but not a full meal at least 2 hours before the procedure. If you are an insulin dependent diabetic do not alter your normal food intake. Take your routine medications before the procedure (such as high blood pressure and diabetes medications). Stop aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro) 3 days before the procedure. These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are on coumadin, heparin, lovenex, plavix or ticlid you must notify our office so that the timing of stopping these medications can be explained. If you are on antibiotics please notify our office, we may wait to do the procedure. If you have an active infection or fever we will not do the procedure. You will be in the hospital as an out-patient for 2-3 hours even though you see the physician for 20 minutes. You will need to bring a driver with you. You may return to your current level of activities the next day including return to work.
