Cervical spine epidural steroid injection video

General pre/post instructions
Patients can eat a light meal within a few hours before the procedure. If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications. (. high blood pressure and diabetic medications). Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. These medicines can be restarted after the procedure if they are needed. If a patient is on Coumadin (blood thinners) or Glucophage (a diabetic medicine) they must notify the office so the timing of these medications can be explained.

This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.  

Once the area is numb, your doctor will use either fluoroscopic imaging -- which uses X-rays to guide the epidural – or CT scans, to administer the epidural injection. Your doctor will slowly guide the epidural needle into the space in your spine that corresponds to your pain. Once the epidural needle is in place, your doctor will inject the medication. You will not feel pain as the needle is placed but you may feel some discomfort as the medicine enters your spine. This should only last a short moment and will most likely dissipate as soon as the injection is complete. Once the medicine has been administered you may feel some tingling. You should tell your doctor if you feel any sharp pain.

The clinical history, physical examination, and imaging is consistent with extensive destruction of the lumbar spine extending over three vertebral segments with associated epidural abcess necessitating surgical decompression and fusion. An epidural abscess may present rapidly with neurological compromise. Prognosis improves with prompt decompression, but only 18% of patients with frank abscess and 23% of patients with paralysis completely recover after decompression.

Hadjipavlou et al report in their Level 4 study that leukocyte counts were elevated in % of spondylodiscitis cases. The erythrocyte sedimentation rate was elevated in all cases of epidural abscess.

The article by Harrington et al states that the surgical indications for an epidural abcess include: unsuccessful antibiotic treatment after 6 weeks, vertebral deformity or instability, neurological deficit, MRI showing > 50% compression of thecal sac, and depressed host immune response.

Illustration A shows radiographs following anterior debridement, corpectomy, fibular strut grafting, and Kaneda instrumentation.

Cervical spine epidural steroid injection video

cervical spine epidural steroid injection video

The clinical history, physical examination, and imaging is consistent with extensive destruction of the lumbar spine extending over three vertebral segments with associated epidural abcess necessitating surgical decompression and fusion. An epidural abscess may present rapidly with neurological compromise. Prognosis improves with prompt decompression, but only 18% of patients with frank abscess and 23% of patients with paralysis completely recover after decompression.

Hadjipavlou et al report in their Level 4 study that leukocyte counts were elevated in % of spondylodiscitis cases. The erythrocyte sedimentation rate was elevated in all cases of epidural abscess.

The article by Harrington et al states that the surgical indications for an epidural abcess include: unsuccessful antibiotic treatment after 6 weeks, vertebral deformity or instability, neurological deficit, MRI showing > 50% compression of thecal sac, and depressed host immune response.

Illustration A shows radiographs following anterior debridement, corpectomy, fibular strut grafting, and Kaneda instrumentation.

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