Fluoroscopy
Epidurals

Indications:

An epidural injection may be indicated to treat localized pain in an upper or lower limb that originates from a nerve root.
 

Results:

Epidurals can provide significant relief of pain caused by nerve root irritation or compression. Relief duration varies and depends on the specific underlying condition.
 

Procedure:

With the patient lying, the skin is disinfected and a local anesthetic is applied as needed. The procedure is performed under fluoroscopic guidance. A very small amount of contrast agent is injected to ensure the needle is properly positioned. A solution containing cortisone, with or without a local anesthetic, is then injected. The needle is removed and the patient returns to the waiting room for about 20 minutes to confirm there is no allergic reaction to the injected substances.
 

There are many types of epidural injections.
 

Caudal epidural:
The needle is guided to a small space between the sacrum and the coccyx.
 

Transforaminal epidural:
The needle is guided near where the root emerges between two vertebrae.
 

Interlaminar epidural:
The needle is guided from the back of the spine between two vertebrae and into the epidural space.
 

This technique is generally well tolerated, although some pain may be experienced during the injection.
 

Patients injected in the epidural space cannot drive a vehicle for at least four hours following the procedure as they may experience tingling or weakness in the legs from the medications injected during the epidural.
 

Side effects:

Patients may experience an increase in pain for a few hours post-injection. Applying ice and using a simple analgesic, such as acetaminophen, help to reduce the pain. Flushing (redness and heat) of the face may occur and is a potential side effect, not an allergic reaction. Women’s menstrual cycle may be disrupted. People with diabetes may experience increased blood-sugar levels for a few days.
 

Complications :

Complications are essentially related to the injection, the anatomy involved and the substances injected. Complications are very rare. Using radiography to confirm the injection’s pathway enhances the safety of the procedure. Furthermore, we use digital subtraction technology to enhance visualization and safety. The risks of complications, such as infection or hemorrhaging, are the same as for any other type of injection, and are quite exceptional.
 

Precautions:

Use of anticoagulants and Plavix must be stopped for cervical and dorsal epidurals. The patient’s prescribing physician must authorize a temporary pause of these medications. Fluoroscopy-guided injections are contraindicated during pregnancy. Report all allergies to medications or contrast agents to the physician.