Spinal Tap - 1st Person Perspective

This is how I will be spending my morning tomorrow:

What is an epidural steroid injection?

An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve.



[Drawing of a disc herniation compressing the spinal nerve root]



An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.

How is an epidural steroid injection performed?

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: "Is that all?"

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of "durable"). The Greek word "epi" means "outside of." So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

[Epidural steroid injection with injection needle visible in the epidural space using a fluoroscope]

When are epidural steroid injections used?

Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy.

I've had problems with my back for the last fifteen years, but I generally work myself out of it in a few days or get some help from my chiropractor. This current bout has been extremely bad, however, and has gone on for nearly a month now. I'm one of those guys that can eat pain like candy, but this is even starting to wear on me, so I went to see an orthopaedist.

After initial x-rays, and then an MRI, I was advised that I had a mild and normal state of degenerative disc disease in my lowest disc with a very slight bulge in the disc. Good news overall, but even a small bulge pressing against the sciatic nerve can bring a grown man to his knees. I do well once I'm on my feet, but. . .I dread getting out of bed in the morning, or having to sit for long periods. When I first get out of bed, and my right leg hits the floor, it's like having a 6 inch knife shoved into my right hip, and I have to hang onto door frames or whatever I can find to move along until it numbs a bit. This "block" should mask the pain and give me time to heal, and I am optimistic.

If not, there's always the new and less-invasive frontal-entry form of back surgery. Typically, when one undergoes surgery of the spine, the back muscles are cut to access the area in need of repair. The healing of those back muscles can keep you down for weeks at best, and often for months. The new procedure generally allows a patient to return to work in a week or two - so I am optimistic overall.

If you are an invincible twenty-something like I once was, and enjoy lifting and tossing heavy things around because it makes you feel manly and causes you no pain, remember this. . .that was ME 15 years ago - it WILL catch up with you eventually. Lift properly now or write this tale about yourself later!