Lumbar Epidural Injections

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Lumbar disc herniation
  • Lumbar disc degeneration
  • Lumbar spinal stenosis with radiculopathy
  • Sciatica
  • Post-laminectomy syndrome
  • Annular tears
CONTRAINDICATIONS
  • Systemic infection or localized infection at injection site
  • Bleeding diathesis
  • Uncontrolled diabetes mellitus
  • Congestive heart failure
  • Pregnancy
  • Allergy to injection materials
EQUIPMENT
  • Fluoroscopy unit
  • Resuscitative and monitoring equipment
  • Pain management table
  • Isopropyl alcohol
  • Povidone-iodine
  • ¼-inch, 27-gauge needle
  • 1% preservative-free Xylocaine without epinephrine
  • 3½-inch, 22-gauge spinal needle
  • 18-gauge hypodermic needle
  • 3½-inch, 17-gauge Tuohy epidural needle
  • 10-mL syringe (2)
  • 5-mL syringe
  • Nonionic contrast dye
  • 6 mg/mL Celestone Soluspan
  • 4¾-inch, 22-gauge spinal needle
  • 0.75% preservative-free bupivacaine
  • 0.75% preservative-free Marcaine
ANATOMY
  • 5 lumbar vertebrae with associated nerve roots that exit below the pedicle for which they are named.
  • Nerve root irritation: mass effect from local pathology
  • Anatomy posterior to the epidural space:
    • Superficial landmark: spinous processes
    • Deeper bony landmark: lamina
    • Overlying epidural space: ligamentum flavum
    • Epidural space: contains nerve root covered in dura mater

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Interlaminar Approach
  • Post-Procedure: Transforaminal Approach
  • Post-Procedure: Caudal Approach

Post-Procedure: Interlaminar Approach

POST-PROCEDURE CARE
  • Complete pain scale assessment.
  • Monitor 30-60 minutes.
  • Do not drive home.
  • Avoid exertional activity for 24 hours.
COMPLICATIONS
  • Vasovagal reaction
  • Dural puncture
  • Postdural puncture (positional) headaches
  • Headache without dural puncture
  • Epidural abscess
  • Epidural hematoma
  • Durocutaneous fistula formation
  • Cushing's syndrome
  • Facial flushing
  • Insomnia
  • Low-grade fever
  • Transient back or lower extremity pain
ANALYSIS OF RESULTS

More than 40 mostly uncontrolled studies on more than 4000 patients have been published on the efficacy of cervical and lumbar epidural steroid injections, which generally indicate that there is strong support for short term efficacy but limited long-term benefit.

OUTCOMES AND EVIDENCE
  • Kepes and Duncalf: 60% effectiveness.
  • White, Derby, and Wynne: success rate of 75%
  • Botwin et al: 65% with significant improvement at 6 weeks post-injection, 62% at 6 months, and 54% at 12 months.
  • Ackerman and Ahmad: 83.3% in the transforaminal group had at least partial pain relief, compared to 56.6% in the caudal group and 60% in the interlaminar group.
Procedure: Interlaminar Approach

Post-Procedure: Transforaminal Approach

POST-PROCEDURE CARE
  • Complete pain scale assessment.
  • Monitor 30-60 minutes.
  • Do not drive home.
  • Avoid exertional activity for 24 hours.
COMPLICATIONS
  • Vasovagal reaction
  • Dural puncture
  • Postdural puncture (positional) headaches
  • Headache without dural puncture
  • Epidural abscess
  • Epidural hematoma
  • Durocutaneous fistula formation
  • Cushing's syndrome
  • Facial flushing
  • Insomnia
  • Low-grade fever
  • Transient back or lower extremity pain
ANALYSIS OF RESULTS

More than 40 mostly uncontrolled studies on more than 4000 patients have been published on the efficacy of cervical and lumbar epidural steroid injections, which generally indicate that there is strong support for short term efficacy but limited long-term benefit.

OUTCOMES AND EVIDENCE
  • Kepes and Duncalf: 60% effectiveness.
  • White, Derby, and Wynne: success rate of 75%
  • Botwin et al: 65% with significant improvement at 6 weeks post-injection, 62% at 6 months, and 54% at 12 months.
  • Ackerman and Ahmad: 83.3% in the transforaminal group had at least partial pain relief, compared to 56.6% in the caudal group and 60% in the interlaminar group.
Procedure: Transforaminal Approach

Post-Procedure: Caudal Approach

POST-PROCEDURE CARE
  • Complete pain scale assessment.
  • Monitor 30-60 minutes.
  • Do not drive home.
  • Avoid exertional activity for 24 hours.
COMPLICATIONS
  • Vasovagal reaction
  • Dural puncture
  • Postdural puncture (positional) headaches
  • Headache without dural puncture
  • Epidural abscess
  • Epidural hematoma
  • Durocutaneous fistula formation
  • Cushing's syndrome
  • Facial flushing
  • Insomnia
  • Low-grade fever
  • Transient back or lower extremity pain
ANALYSIS OF RESULTS

More than 40 mostly uncontrolled studies on more than 4000 patients have been published on the efficacy of cervical and lumbar epidural steroid injections, which generally indicate that there is strong support for short term efficacy but limited long-term benefit.

OUTCOMES AND EVIDENCE
  • Kepes and Duncalf: 60% effectiveness.
  • White, Derby, and Wynne: success rate of 75%
  • Botwin et al: 65% with significant improvement at 6 weeks post-injection, 62% at 6 months, and 54% at 12 months.
  • Ackerman and Ahmad: 83.3% in the transforaminal group had at least partial pain relief, compared to 56.6% in the caudal group and 60% in the interlaminar group.
Procedure: Caudal Approach
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