The epidural injection is given to relieve radicular arm or leg pain by reducing the inflammation of a compressed or pinched nerve, which is seen in disc herniation or spinal stenosis cases. In this procedure, drugs are administered in the midline epidural or through the transforaminal epidural space. When it is used specifically to numb or relieve the pain of one targeted nerve root- it is called a Selective Nerve Root Block.

Facet joints are the small joints located between each vertebra on the back of the spine. These joints can be the source of back pain caused by degenerative/arthritic conditions or injury. During facet injection drug is administered directly into the joint or to anesthetizing the nerve carrying the pain signal.

There are two SI joints are located between the sacrum and ilium (pelvic) bones on each side. This joint can be a source of chronic back pain with or without radicular leg pain, which is commonly caused by inflammatory joint conditions such as spondyloarthropathy or rheumatoid arthritis, prior spine surgery which displaces pressure more to SI joint or following pregnancy or childbirth. During SI joint injection drugs are injected directly into one or both of the sacroiliac joints.

Anesthesia

• The procedure is performed in local anesthesia and the patient will be fully awake.

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Patient position

• Patients are made to lay down on the stomach (prone position).

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Procedure

• The procedure is done under the guidance of an X-Ray (fluoroscopy) machine, the correct level is identified, 3-5 ml local anesthesia is injected to numb the site of injection, followed by insertion of the spinal needle into transforaminal epidural space, facet or SI joint for respective blocks. After confirming the correct needle placement, a mixture of Inj Bupivacaine 0.25% and Inj Triamcinolone 1 ml are injected. The total procedure time 10-15 min approximately.

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Post-Operative Care

• Pain is improved immediately after the injection. A patient may feel little numbness in the leg or some soreness at the injection site. After observation for a while, the patient can be sent home.

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Home Care

• The patient is advised to take rest for the remaining day but allowed to walk in and around home. From next morning onwards, advised to walk and stay active as possible. Can climb stairs if required. The patient should avoid prolong sitting (>45-60 min) and avoid bending at the waist, lifting (more than 2-3 kg)

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Injection site Care and follow up

• Cold fomentation as and when required for the soreness at the injection site and the patient will be called in OPD after 7 days of injection to evaluate the response of injection and change of medication if needed.

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Return to work

• The patient can resume light work or driving once the pain is tolerable, usually in a week. While heavy work and sports activity should be avoided for at least 4-6 weeks.

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Complications

Spinal injections are very safe procedures, however, like any other procedure there can be several risks and complications such as:

• Bleeding
• Infection
• Spinal headache
• Muscle weakness
• Increased pain

Common side effects from steroids include:

• Increased blood sugar
• Facial flushing
• Increased appetite
• Nausea
• Diarrhea

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