EPIDURAL STEROID INJECTIONS and LYSIS OF ADHESIONS

The Epidural Steroid Injection can be given in the neck (cervical), middle back (thoracic) or lower back (lumbar), depending on the location of your pain. 

What is the purpose of an Epidural Steroid Injection?

The Epidural Steroid Injection is a procedure where a steroid (anti-inflammatory medication) and/or anesthesia (numbing medication) are injected into the epidural space to treat pain, which is caused by the irritation of the spinal nerves. Epidural injections are given for the relief of arm or leg and neck or lower back pain from nerve irritation or damage resulting from problems such as shingles, ruptured discs, degenerative disc disease, and spinal stenosis or failed back surgery. A protective covering called the dural sac surrounds the spinal cord and contains spinal fluid that nourishes the spinal cord.  The space between the outer surface of the dural sac and the bones of the spinal column is the epidural space.  Nerves that go from the spinal cord, through the spinal column and to the body pass through the epidural space.

We can now use a patient's own growth factors instead of sterods and avoid the riisks associated cortisone.

What does the procedure involve?
 
The Epidural Steroid Injection is an outpatient procedure done in a Special Procedure Room.  For your safety, the nurse will connect you to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device. You will lie on your stomach with a pillow underneath your abdomen so you are in the correct position.  After your skin is cleansed with an antiseptic solution the doctor will inject some numbing medication that will produce a burning sensation for a few seconds.

After the numbing medicine takes effect, the doctor will insert another needle and with the guidance of a special X-ray machine called a fluoroscope, inject a contrast dye to confirm the needle is in place.  Once the needle is in the correct place, the doctor will inject a mixture of the numbing medicine (anesthetic) and anti-inflammatory medicine (cortisone/steroid).  It is possible you will feel pain or pressure similar to your normal back pain as the medicine is injected.  This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly.

After the procedure, we ask that you remain at the Center until the doctor feels you are ready to leave.

Can I go to sleep for the procedure?

It is not necessary for you to go to sleep for this procedure; if needed, you will receive enough medication to keep you comfortable.

How long will the procedure take?

Normally, an epidural steroid injection takes no more than 10 or 15 minutes.

What should I do before the procedure?

If you will be receiving sedation, it is recommended that you do not eat eight hours before the procedure.  If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor.

You may need to stop taking certain medications several days before the procedure.  Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements.  Please bring a list of medications and dosages the day of your procedure.

It is very important to tell the doctor if you have asthma, if you have had an allergic reaction (i.e. hives, itchiness, difficulty breathing, and any treatment which required hospitalization) to the injected contrast dye for a previous radiology exam (CT scan, angiogram, etc.).  Also tell the doctor if you have ever had an allergic reaction to shellfish (shrimp, scallops, lobster, and crab).  The doctor may prescribe some medications for you to take before having the procedure.

Tell the doctor if you develop a cold, fever or flu like symptoms before your scheduled appointment. 

Is there anything special that I need to do after the procedure?

You may experience some weakness and/or numbness in your legs, arms or chest, depending on the location of the epidural site that may last for a few hours after the procedure.

If so, do not engage in any activities that require lifting, balance and coordination.  Drink plenty of clear liquids after the procedure to help remove the contrast dye from the kidneys.  After your procedure we recommend that you do not take a hot shower or bath.  You make take a shower as long as the water is lukewarm. It is recommended that you do not drive for the remainder of the day. Please have an adult drive you home or accompany you.  You may resume your normal activities as tolerated.

If the doctor prescribes physical therapy, it is very important that you follow through with the physical therapy program. 

Although you may feel much better immediately after the injection (due to the anesthetic that is used), there is a possibility your pain may return within a few hours.  It usually takes between 3-7 days for the steroid medication to start working.

What are the risks of Epidural Steroid Injection?

The risks, although infrequent, include: Allergic reaction to the medication; Bruising at the injection site; Infection at the injection site; Nerve damage; Puncture of dura resulting in a headache.

If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, please call the doctor as soon as possible.

 

LYSIS OF ADHESIONS

What is the purpose of Lysis of Epidural Adhesions?

Lysis of Epidural Adhesions has been developed as a procedure for patients suffering from lower back pain and pain that radiates down the thigh, calf and foot.  Adhesions (fibrosis) may form after back surgery or from leakage of disc material into the epidural space.  The word “lysis” means to destroy or break up material.  Inflammation, compression of nerve roots and the disc material that surrounds the nerve roots cause severe pain.  Using a semi-rigid catheter, the doctor is able to break up the adhesions, flush out the disc material, and direct medication onto the inflamed area and nerve root.  This procedure is performed after more conservative treatment options, such as; medications and epidural steroid injections have failed to relieve your pain.

What does the procedure involve?

Lysis of epidural adhesions is an outpatient procedure that is done in a Special Procedure Room under strict sterile conditions.  For your safety, the nurse will connect you to monitoring equipment (EKG monitor, blood pressure cuff and a blood-oxygen monitoring device).

The procedure is done with you lying on your stomach.  The doctor will cleanse your lower back with antiseptic solution before injecting some numbing medication.  You may feel a burning sensation for a few seconds.  After the numbing medication has taken effect, the doctor will make a small incision and insert a dilator tube in which the catheter will pass.  You should not feel pain during the procedure; however, you may feel a sense of pressure. The doctor will manipulate the catheter to the area suspected of causing your pain with the help of a special X-ray machine called the fluoroscope.  The doctor may periodically inject a contrast solution to confirm the correct location. The catheter is placed into the epidural space to mechanically loosen and/or remove adhesions from the nerve roots.  Hypertonic saline can be injected through the catheter at the area of fibrosis to disrupt adhesions and reduce edema (swelling).  The doctor will inject a mixture of numbing medicine and anti-inflammatory medicine, once the suspected pain producing area is located. 

After the procedure, we ask that you remain at the Center until the doctor feels you are ready to leave.

Can I go to sleep for the procedure?

It is not necessary for you to go to sleep for this procedure; if needed, you will receive medication to keep you comfortable.


How long will the procedure take?

Normally, lysis of epidural adhesions takes from 30 minutes to an hour. 

What should I do before the procedure?

If you receive sedation, it is recommended that you do not eat anything after midnight the day before your test.  If you are on medication, you may take them with sips of water.  If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor.

You may need to stop taking certain medications several days before the procedure.  Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements.  Please bring a list of medications and dosages the day of your procedure.

It is very important to tell the doctor if you have asthma, if you have had an allergic reaction (i.e. hives, itchiness, difficulty breathing, and any treatment which required hospitalization) to the injected contrast dye for a previous radiology exam (CT scan, angiogram, etc.).  Also tell the doctor if you have ever had an allergic reaction to shellfish (shrimp, scallops, lobster, and crab).  The doctor may prescribe some medications for you to take before having the procedure.

Tell the doctor if you develop a cold, fever or flu like symptoms before your scheduled appointment. 

Is there anything special that I need to do after the procedure?

You may experience an increase in your usual pain including muscle soreness in your back where the catheter was inserted.  Use ice packs three to four times a day and take your usual pain medication.  Do not apply heat or soak in water.  We recommend that you do not take a hot shower or bath the day of your procedure.  You may take a lukewarm shower if necessary.

Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys.

It is recommended that you do not drive for the remainder of the day.  Please have an adult drive you home or accompany you.  You may resume your normal activities as tolerated.

You may feel almost pain free immediately after the injection due to the numbing medication.  Your pain may return within a few hours, as it takes a few days for the steroid medication to work. 

What are the risks of Lysis of epidural adhesions?

Although very few complications have been reported, the risks involve: spinal puncture resulting in a headache; infection at the site; infection in the spinal canal; bleeding inside the epidural space, nerve damage and visual disturbances.

 If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, please call the doctor as soon as possible.

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IN LOVING MEMORY OF YASMIN ALGARIN

Yasmin was, and always will be, a shining example of a how a person can achieve anything with hard work and a life-affirming attitude. She gave more than she took, she loved more than she feared, and she nurtured her family and friends at every opportunity. We will always remember Yasmin as a woman of strength, courage and compassion. 

Due to her untimely passing from brain cancer, we have set up a trust fund for her two children, Niles and Nylah. Please make your checks payable to: The YANN Trust (Yasmin Algarin Niles Nylah), 197 Ridgedale Ave., Suite 210, Cedar Knolls, NJ 07927.

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DISCLAIMER

The pages on this website contain general guidelines and information based on acceptable standards and should not be construed as medical advice. 

Please consult your own physician for appropriate management about your medical condition.