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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young

Epidural Injection For Back Pain

Research studies have shown the benefit of epidural steroid injections for spinal disc lesions causing Sciatica. The purpose of the injection is to carry the medicine to the inner part of the back where the more serious types of strain, affecting the discs or joints, cause pressure or irritation of the nerves. The structures are bathed by the anti-inflammatory steroid to reduce swelling and pain.

The solution contains a mixture of saline and corticosteroid (not Depomedrone). It may be injected by the caudal route (just above the tail-bone) or between the spinous processes. The injection can be performed safely as an out patient or day case procedure without the need for overnight stay or general anaesthetic. In the majority of cases it is not a painful procedure, although you may experience some feeling of pressure as the volume of fluid is pushed in, or reproduction of your sciatic pain temporarily. After the procedure, you will be expected to rest for a while (20 minutes or longer) before going home.

With the 'caudal epidural injection' you may experience some temporary light headedness after the procedure. If a different type of epidural ('interlaminar epidural') is used using local anaesthetic, there may be some weakness or unsteadiness after the injection. For this reason, you should not drive a vehicle or operate machinery until the next day. The benefit may appear almost immediately or build up gradually over a week or 10 days. It is extremely unlikely that you will experience any other significant side effects. Due to the corticosteroid component, some women may develop a facial flush the next day which lasts 12-24 hours and, less commonly, some disruption of the menstrual cycle for one or two cycles. Other possible complications are similar to those of any injection and very rare, namely infection or allergic reaction which can occur in approximately 1 in 7,000 cases and can be dealt with promptly. There is no satisfactory evidence of any long term complication from epidural steroids.

Using X-ray guidance, the physician will identify the base of the sacrum before administering the injection. He may have an nurse or assistant who helps during the procedure. A non-ionic contrast dye may be injected so that the physician can identify correct placement of the epidural injection. The steroid/saline solution is then injected slowly over a period of about 10 minutes. The needle enters the spinal canal through the base of the sacrum, and the saline mixed with steroid penetrates up the canal to reach the level of the third lumbar vertebra.

If the pain relief is short-lived but significant, the epidural injection may be repeated to give a longer-lasting effect, so do not be too disappointed if the pain eventually returns after the first injection. Your pain may be the same, or worse in some cases than before the procedure. This will last for 24-48 hours and is part of the normal process.

The procedure will be fully explained to you before your appointment. If you have any further questions, please ask - or visit our FAQ section. Please report any known allergies (drugs, elastoplast etc) to the doctor prior to the procedure. Most people leave the Clinic within one hour of their appointment. You will need a competent adult to drive you home and if you live alone, please ensure that you have a competent adult to take care of you until the following day. After any procedure, it is advisable to go home and rest (preferably lying down) for the remainder of the day and preferably the next day too. The doctor will guide you as to the exact amount of rest needed. Sitting and any long car journeys are to be avoided.

If in the rare event you do experience any untoward reaction in the following 24 hours, such as shortness of breath, dizziness or severe headache, please contact the Clinic immediately, or if it is out of hours, contact your GP or go directly to the Accident and Emergency Department of your local hospital.