Epidural steroid lumbar stenosis

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Epidural injections are often used to treat radicular pain, also called sciatica , which is pain that radiates from the site of a pinched nerve in the low back to the area of the body aligned with that nerve, such as the back of the leg or into the foot. Inflammatory chemicals (. substance P, PLA2, arachidonic acid, TNF-α, IL-1, and prostaglandin E2) and immunologic mediators can generate pain and are associated with common back problems such as lumbar disc herniation or facet joint arthritis . These conditions, as well as many others, provoke inflammation that in turn can cause significant nerve root irritation and swelling.

An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.  Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections also are used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy.

The benefits from the first shot only lasted 2 weeks. The second and third set of injections lasted about 90 days. In November, I was ready to have surgery. My EMG and nerve conduction tests proved that the nerves were "sleeping" before I was. After another MRI, the neurosurgeon said I was a candidate for surgery but I was not able to get the endoscopic type surgery that is less invasive. I would have an incision about 6-8" long. Along with removing the herniation, they would have to increase the size of the hole where the nerve roots were going through.

The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (. Coumadin, injectable Heparin), or if you have an active infection going on. With blood thinners like Coumadin, your doctor may advise you to stop this for 4-7 days beforehand or take “bridge therapy” with Lovenox prior to the procedures. Anti-platelet drugs like Plavix may have to be stopped for 5-10 days prior to the procedure. Aspirin should be stopped for cervical procedures for 10 days prior, but not for Lumbar.

Epidural steroid lumbar stenosis

epidural steroid lumbar stenosis

The benefits from the first shot only lasted 2 weeks. The second and third set of injections lasted about 90 days. In November, I was ready to have surgery. My EMG and nerve conduction tests proved that the nerves were "sleeping" before I was. After another MRI, the neurosurgeon said I was a candidate for surgery but I was not able to get the endoscopic type surgery that is less invasive. I would have an incision about 6-8" long. Along with removing the herniation, they would have to increase the size of the hole where the nerve roots were going through.

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