Epidural Spine Injection

An epidural injection helps treat low back symptoms related to canal narrowing or nerve compression from a disc herniation or degenerative disease. Using X-ray guidance, we inject an anesthetic and steroid around nerves into the spinal canal (interlaminar) to help relieve symptoms.

We also perform cervical epidural (trans-facet) injections where local anesthetic and a steroid are injected into a facet joint in the neck. The joint capsule is completely filled in order to push the medication out of the joint and into the adjacent pinched nerve. Cervical epidurals can be used as a treatment to relieve neck pain and referred symptoms into the arm.

Relief may occur within two weeks and can last 3-6 months, or longer. Often MRI is requested prior to this treatment to confirm the diagnosis, select the best injection site, and avoid complications. If successful, repeat injections can be performed.

HOW DO I PREPARE FOR MY PROCEDURE?

• You must have had an MRI or CT within the past 24 months.
• If you’ve had recent surgery, but not updated your images, please inform the booking coordinator prior to injection.
• For a trans-facet cervical epidural, it’s recommended that you do not wear jewelry around your neck or in your ears to your appointment. If you have long hair, please bring a hair tie to your appointment to keep your hair secured during the injection.
• If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin, etc.) you will need to have an international normalized ratio (INR) test and temporarily stop your medication prior to the procedure. Please inform our booking coordinators so that they can discuss this in more detail with you.
• IMPORTANT: Please schedule your injection either two weeks before or one week after any vaccination appointment.
• If you are currently taking antibiotics, you will need to wait two weeks after your last dose before having your injection.
• Take all prescribed medications as directed.
• You must have a driver accompany you to this appointment.
• If you have diabetes, please eat one hour before your appointment.
• Please arrive 15 minutes before your appointment to allow enough time to check in with reception and fill out a consent form.
• Bring photo identification and your provincial health card.
• Wear comfortable clothes.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• A team member will go over your consent form, explain the procedure, and answer any questions you may have.
• We will then escort you to our treatment suite where you will meet the radiologist who will clean the skin and inject a local anesthetic, similar to the freezing you get at the dentist.
• The needle is then positioned under X-ray guidance and the correct location on the body is confirmed. To double-check the location, a short-acting anesthetic is injected in conjunction with neurologic testing. Once proper needle position is confirmed, the therapeutic medication is then injected.
• For a trans-facet cervical epidural, you will be asked to lie on your stomach with your neck flexed and your forehead resting on the table. This opens the facet joints for easier access with the needle.
• It is possible you will feel pain or pressure similar to your normal back pain as the medicine is injected. This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly.
• A Band-Aid will be placed at the injection site, then you will be transferred to a wheelchair and brought into another room.
• After 15 minutes, you will be checked for the expected injection response. If you are able to stand and walk safely, you will be free to leave with your driver.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours:
  • Keep the treatment area clean. Leave the Band-Aid on. Do not shower.
  • Avoid driving.
  • If possible, please avoid anti-inflammatory medication for 24 hours (i.e., ibuprofen/Advil).
  • A feeling of heaviness, numbness, or tingling in one or both legs is normal and could last for 4-6 hours.
• First 48 hours:
  • Avoid bathtubs, hot tubs, and pools.
  • Avoid strenuous activities and lifting for 3-5 days.
• After one week: You may resume strenuous activity, lifting, and physiotherapy. Be mindful of your pain and stop if it hurts too much. Notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• Watch for symptoms of bleeding around the spine: If you have intense lower back pain that comes quickly and travels down one or both legs and continues to intensify, please call 911 or go to an emergency room right away.
• If you develop a headache that improves when lying down and worsens when sitting up, try drinking caffeinated beverages (coffee/tea), taking Tylenol (if there are no contraindications), and rest. If the headache persists into the next day, seek medical attention from your family physician.
• If you have pain or other symptoms beyond 48 hours after your injection, this is a normal reaction. You may apply heat and ice to the treatment area. If you have any questions, please email us at paintherapy@radiology.ca during business hours.
• Diabetics: Note that cortisone can cause a temporary increase in blood sugar. Please monitor your blood sugar closely and if you have any concerns, consult with your doctor.
• Anti-coagulant therapy: You will be directed when to resume any anti-coagulant (blood thinners) medication.

WHEN WILL I SEE RESULTS?

• After your injection, the freezing may last for a few hours. Your symptoms may return until the steroid takes effect in two weeks. Please track your symptom response to share with your physician.
• These injections typically provide at least three months of symptom relief. If an injection does not help relieve your symptoms, then you may need further evaluation by your referring doctor for another cause of your symptoms.
• Please consult with your doctor regarding your results and any follow up exams or questions.

HOW MUCH WILL IT COST?

This exam is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinics.