What is the epidural space?

The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck and into the arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.

What is an epidural steroid injection and why is it helpful?

An epidural steroid injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the neck or arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

General Pre-Injection Instructions:

Be sure to tell Dr. Moradian/Dr. Vartanian if you have an allergy, particularly to iodine. If you will be receiving sedation, you should NOT eat the morning of the procedure. If a patient is an insulin dependent diabetic and receiving sedation, they may need to change their morning dose of insulin to account for not eating the morning of the procedure. Patients may take their routine medications (i.e., high blood pressure and diabetic medications, e.g. Glucophage).

Patients should continue to take pain medications or anti-inflammatory medications the day of their procedure. If a patient is on Coumadin or another blood thinner, they should notify Dr. Moradian/Dr. Vartanian so an appropriate plan can be made for stopping the medication before the procedure. Although not mandatory, we generally recommend that a driver should accompany the patient and be responsible for getting them home.

What happens during the procedure? An IV will be started before the procedure. The patient is placed on their stomach so the x-ray can be used to visualize the spine. The skin on the neck is scrubbed using antibacterial soap. Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a needle into the epidural space. A mixture of numbing medicine (local anesthetic) and anti-inflammatory (steroid) is injected.

What happens after the procedure? There are no restrictions to food or liquid intake or to activity level unless specified by Dr. Moradian/Dr. Vartanian. A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three, about one month apart. The neck or arms may rarely feel weak or numb for a few hours.