As the name of this procedure suggests, it means injecting medicine in the epidural space or the space that is placed on the dura (around the spinal canal). This space is located from above to the foramen magnum and from below to near the end of the sacrum and surrounds the spinal canal. This space also includes nerve roots.
Epidural space is a space full of fat and blood vessels and has the ability to increase volume.
In various diseases in which the nerve roots are under pressure for any reason, such as: disc herniation, spinal canal stenosis, adhesions caused by previous operations, etc., steroid or other drugs can be injected around the nerve root involved in inflammation and Control and treat pain caused by pressure. Also, in controlling the pain in the nerve areas related to each of the nerve roots, it is possible to control the pain related to that area by injecting medicine or using radiofrequency waves, or in other words, block the nerve root. For example, control and treatment of discogenic pains (Internal disc disruption) or pain control during surgery or pains caused by malignancy, etc.
Types of epidural injections:
Inter laminar:The place where the needle enters is between the lamina of two neighboring vertebrae, and actually the back part of the epidural space is targeted. In this method, it is not possible to specifically target a nerve root, and at the same time, depending on the amount of drug and the volume used, several levels are blocked.
Transforaminal:In this method, the nerve roots can be targeted more specifically, and in this way, it will also be useful for diagnosis, to find the involved root and make subsequent decisions. Also, more than other methods, the drug is spread in the front part of the epidural space.
caudal: The place of needle entry will be from the sacral hiatus and again like interlaminar, specific block is not done and several nerve roots are targeted at the same time. This type of epidural injection is only used to treat lower back problems
How to perform epidural injection:Due to the importance of observing the sterility conditions and the sensitivity of the work due to the vulnerability of the nerve roots and proximity to the spinal cord, this treatment method is performed in hospitals or centers equipped with the necessary facilities and under the guidance of a fluoroscope.
A week before the treatment, the patient should stop taking medications that interfere with blood coagulation. (like aspirin)
This procedure does not require general anesthesia and is performed only with local anesthesia. Of course, in certain circumstances, it may be necessary to use intravenous drugs for sedation.
After doing the work, the patient is monitored for a few hours and then discharged.
It should be noted that due to the length of the effect of this treatment, it may need to be repeated. This treatment can be repeated at the same level up to three times a year.
Author: Dr. Hossein Arjamand