EPIDURAL STEROID INJECTION & EPIDURAL NEUROPLASTY FOR SCIATICA

Radicular Lower limb pains caused by a herniated lumbar disc is not simply due to mechanical compression but is also due to the release of different kinds of inflammatory mediators including phospholipase A2 and prostaglandin E2 from the herniated nucleus pulposus. Sciatica due to a herniated lumbar disc, there are both surgical and conservative approaches. It has been reported that in cases where interventional pain procedures like Epidural Neuroplasty or Epidural Steroid injections succeed in providing pain relief for a year or more surgery is prevented in more than 78% cases.

Among the three epidural steroid injection methods, Transforaminal epidural block (TFESI), interlaminar epidural steroid block, and caudal epidural steroid block, the TFESI is the most effective method because TFESI enables the injection of a high dose of steroid directly into the ventral epidural space where there is maximum in inflammation. Epidural adhesions are most commonly seen after lumbar disc surgeries. Epidural neuroplasty (NP)’ or ‘epidural adhesiolysis’ is a more effective treatment for such patients.

Who can benefit from an epidural steroid or neuroplasty procedure?
Patients with conditions like – disc herniation, degenerative disc disease, and spinal canal stenosis, failed back surgery syndrome, or post-laminectomy scar syndrome – may benefit from an epidural injection.


What are the various approaches for epidural steroid blocks?


Three routes may be used for epidural injections in the lumbosacral spine: caudal,  translaminar, and transforaminal. Your physician will choose which method is right for you.
The transforaminal technique requires a fluoroscope, which is a special x-ray machine that allows your doctor to see “dynamic” images that allow for precise needle placement. This technique is favored because of the precision with which solutions can be delivered to a specific nerve root and the front location of the needle in the epidural space. Several different steroid preparations may be used, with or without local anesthetic, to increase the volume and ensure the spread of medication to all areas causing pain.


What are the contraindications for epidural steroid blocks?
There are a few contraindications to performing lumbosacral epidural steroid injections, including bleeding disorder, anticoagulation, and allergy to medications. Other contraindications include pregnancy and the inability to be positioned horizontally or to “lie prone”. Diabetes and congestive heart failure require caution by the doctor performing the procedure. The current use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication, but some Pain Specialists opt to have their patients stop using these medications up to 7 days before the planned injection in order to reverse the antiplatelet effect, depending on the physician’s preference.

Is any anesthesia used for the procedure? Will there be any pain?

Typically a local anesthetic is injected into the skin, numbing the area where the epidural needle is placed. Patients may experience a mild discomfort but not severe pain.


Will I have to lie prone for an extended period of time during and after the procedure?
The procedure can last anywhere from 15-30 minutes and requires the patient to lie prone or on the side. After the procedure, patients are asked to rest in a supine [flat on his/her back] or sitting position for a brief time.


Who performs epidural steroid injections?
Epidural steroid injection at Hospital for Special Surgery is performed by  Interventional pain specialists or  pain management physicians all of whom have the expertise necessary to safely perform this procedure


How Long Does It Take For The Medication To Work?
Because patients receive an anesthetic prior to the injection, temporary pain relief may last for several hours. The TFESI may not start working to relieve pain for up to 10 days, and during that period, pain may increase, that is normal.

Are There Any Restrictions After The Procedure?
Patients must have someone to drive them home post-procedure and should not drive anywhere else for the rest of the day. Do not take a bath, use a hot tub, go swimming or otherwise immerse in water for the rest of the day after the procedure. Do not place any type of heat over the injection site for 24 hours. Most patients can return to work the day following the procedure.

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