Desert Orthopedic Center: Surgery Center

Pain Management Overview

Comprehensive Spine Center
Surgery Center
Imaging/MRI
Worker's Compensation
Sports Medicine

Procedure Animation

Frequently Asked Questions

Back Pain Articles

Welcome to Desert Orthopedic Surgery Center’s Pain Management Program.

Your Desert Orthopedic Center physician has referred you to an anesthesiologist highly trained in pain management procedures. The most common procedure is the epidural steroid injection. This brochure is meant to help you better understand the procedure.

Anatomy
The spinal cord sits inside a sac called the dura and is bathed in fluid called spinal fluid. Outside the dura, the spinal cord is surrounded by the spinal canal made of vertebra (back bones) and ligaments (connective tissues). The space between the dural sac and the bony canal is the epidural space. It surrounds the spinal cord sac and is filled with fat and blood vessels. The spinal nerves travel through the epidural space when they leave the sac to go to their distribution in the body. Compression of spinal nerves, causing back and leg or arm pain, occurs as the nerves pass through the epidural space. Nerves may be compressed by the discs that sit between the vertebra or by the vertebra themselves. Pressure on the nerves causes pain felt in the area of the body that the compressed nerve serves.

Medications
Steroids (i.e. cortisone) are the most potent anti-inflammatory drugs available. Placing a steroid medication into the epidural space is intended to reduce swelling and inflammation of nerves and connective tissues and hopefully reduce your pain other symptoms. Steroids, like any medication, have side effects and need to be used appropriately and carefully.

How It Is Done
Anesthesiologists are experienced at placing a needle into the epidural space as a common form of anesthesia in surgery. You will be asked to sit or lay on your stomach or side. The appropriate place on your back, between the back bones, will be located using fluoroscopy or x-ray.

Your skin will be cleansed with an antiseptic solution. Local anesthetic will be injected into the skin and tissues under the skin to minimize any discomfort you might have. A small needle will be inserted between the back bones into the epidural space. When the needle is correctly positioned, the steroid medication will be slowly injected. After a brief recovery, you can go home and continue your usual activities.

Risks
Every medical or surgical procedure entails some risks. We believe the risks of epidural steroid injections to be low in relation to the benefits for you, but you need to be aware of the risks. These risks will be discussed with you by your anesthesiologist.

The most common risk of epidural steroid injection, is an accidental puncture of the dural sac. A dural puncture is always done when a patient has a spinal anesthetic or myelogram and is of little concern except a small number of patients may have a post dural puncture headache. Headaches occur less frequently in patients who are older and when a small needle has caused the puncture. If a dural puncture occurs, you will be instructed in how to minimize the chances of dural headache and what to do if one should occur.

Bleeding and infection can occur anytime an invasive procedure is performed. The epidural space contains small blood vessels which may be injured by the needle, but this does not usually lead to any bleeding problems. If, however, you take blood thinners or anticoagulants, bleeding into the epidural space could occur. If you take blood thinners, it will be necessary to have your blood clotting evaluated by a laboratory test before the injection.

Infection risk is minimal, because all of our equipment is sterile and sterile technique is used.
Nerve damage from either the needle or the drugs used is an extremely rare but potential risk. Every case will be taken to ensure safe and appropriate placement of the needle and drug in your epidural space and avoid any damage to your nervous system.

Mental changes from steroid medications are common, but are less likely with epidural injection. There is often a feeling of well-being for a day or two after the injection. Sometimes people feel anxious or jittery for several days. This can be treated so contact your own doctor to discuss it. Very rarely, a patient may have abnormal changes in their thinking which will require careful evaluation and treatment.
While these risks may be frightening, you have the right to know both the risks and benefits of medical procedures. We believe the benefits far outweigh the potential risks. Please feel free to speak to our physicians and medical staff about these risks.

Frequently Asked Questions