Frequently Asked
Questions
An epidural cortisone injection (ESI)
is an outpatient procedure indicated to treat your condition. This
procedure consists of injecting cortisone and saline into the space
around your spinal canal called the epidural space.
The dura is the thin lining that
contains the spinal fluid and nerves. The epidural space is the area
or space between this fluid filled sac and the bones of the
vertebrae. Our goal is to place the tip of the needle near the sac,
but not into it. If the needle is placed in the fluid-filled sac
(through the dura), we have performed a spinal tap.
The injection is usually performed in
the lumbar area at the level of the waist or belt line. If difficulty
is encountered at that area, we sometimes place the needle lower in
the end of the spine near the tailbone.
The procedure is most easily,
comfortably and accurately performed if a fluoroscope is used to
visualize the needle placement. A fluoroscope is an x-ray machine
that allows us to see motion while we place the needle. For this
reason, we perform epidural injections at the hospital where a
fluoroscope is available.
Cortisone is a potent
anti-inflammatory drug. When injected, we hope that the
anti-inflammatory effects of the drug will reduce the swelling and
pain of the inflamed tissues and nerves that are causing your
discomfort. Most patients experience some relief beginning within 24
hours following the injection. It can take 5 to 7 days to obtain
relief. A few patients will get no relief at all. The duration of
relief will vary depending on the underlying condition and its
severity. The procedure can be repeated as frequently as weekly for
three successive weeks. After that, we recommend waiting 3 to 4
months before repeating the injection or pursuing a different
treatment plan.
The procedure is done using strict
sterile technique. This requires a surgical type of cleansing of the
skin and the use of sterile gloves and equipment. You will be awake
during the procedure and we will talk to you and tell you what to
expect throughout the procedure. You will feel a needle stick when
"local" anesthesia is injected to numb the skin and deeper tissues.
When the cortisone and saline are injected you will feel a deep
pressure sensation and perhaps experience some pain. This is usually
of very short duration.
There are potential complications
with this procedure. Occasionally, the dura is penetrated with the
needle. This can lead to a headache that may last up to 24 hours.
Infection is another potential complication, although quite rare.
Bleeding around the area of the injection can also occur, but, is also
very rare.
Strict precautions are taken to
prevent complications and problems. If, however, the needle passes
into the spinal fluid, you are advised to stay at bed rest for 24
hours. This will usually prevent any further problems. If you appear
to have any infected skin lesions near where the needle would be
placed, the procedure would not be performed until the infection can
be cleared up. Bleeding is best avoided by not using anti-coagulant
medication or blood thinning drugs, including aspirin or other
anti-inflammatory pills used to treat arthritic conditions. If you
have questions about this or anything else, ask your doctor
before the procedure.
It is advisable to have someone
accompany you to the facility, so that if necessary, they can drive
you home. If no complications occur, you can continue with normal
activity, including return to work, immediately following the
injection.
There will be three separate charges
for this procedure; the doctors fee, a charge by the hospital for use
of the outpatient facilities, and a charge for the use of the
fluoroscope.
If you have any questions or
concerns, please feel free to contact our office.
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ESI FAQs
