Spinal Injections
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Fri, 07/18/2008 - 19:04
Spinal Injections 101
This thread was going on the last forums, so I wanted to resurrect it here.
When I was first confronted with the idea of an Epidural Steroid Injection (ESI) then a Facet Joint Injection (FJI), I was absolutely terrified! I read about the need for mild sedatives, IV sedation and even general anesthesia, the pain involved and the results of many individuals.
From my experiences- this is how I found ESIs and FJIs work in my Pain Management physician's office.
1) Approximately 30 minutes prior to your appointment, take the prescribed sedatives.
2) Stop taking all other medications the night before (unless your physician tells you it is ok- primarily this refers to blood thinners, aspirin, or anything that may increase the risk of the procedure).
3) Show up 15-20 minutes prior to your appointment so you can fill out paperwork.
4) They will take you in a standard room, take your vital signs, have you sign forms indicating you understand the risks of the ESI.
5) You will then be taken to the procedure room. It is typically like an X-Ray room because the use of Fluroscopy (live X-Ray) is used by most spine-injection physicians.
6) They have you lay down on your tummy on some pillows, and prep the area where you will be receiving the injection (alcohol swabs and Iodine are a popular combo). They hook you up to a BP machine and pulse-ox machine and ECG machine to monitor your vitals throughout the procedure.
7) The physician enters the room and explains the steps he will take.
8) The lidocain (local numbing agent- like they use in a dentists office) is injected and they give you a couple of minutes to allow it to set in.
9) The physician activates the fluroscope and begins to inject the steroids. My physician injects slowly because it creates a burning / cramping sensation in the nearby muscles and nerves.
10) After completion they make you sit around for 20 minutes to make sure you have no adverse reaction.
11) Go home (use a driver!), ice, relax and make sure to keep up on your pain meds.
Typically my pain decreases by about 50% and lasts anywhere from 1month to 4 months- depending on how much stress I have at work, and how much I rest after the procedure. These have been my experiences with both ESIs and FJIs.
Share your ESI and FJI stories in this thread- so readers can have an idea of your experiences and feelings about this procedure.
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28 y/o, L5-S1 Herniation- L-ESI #1: 10/03/07, Cervical Facet Joint Injections C6-C7 and C7-T1: 01/03/08, T-ESI #2: 04/29/08, L-ESI #3: 07/18/08, Started Chiro w/ rehab 02/04/09, T-ESI #4: 02/11/09, C-ESI #5: 09/17/09
My Published Back Injury Articles:
http://www.ehow.com/how_2326493_epidural-steroid-injection-back-pain.htm...
http://www.ehow.com/how_2323277_stop-back-pain.html
My Motto: Taking life 1 day at a time. If 1 day is too much- I'll take it by the minute!
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I had 2 ESI's and 1 FJI.
I was told to stop taking any blood thinning meds (for me that meant I stopped my Relafen) 5 days before the procedure.
I did not have any kind of sedative.
I also did not have any vital monitoring during the procedure, but maybe that is because I wasn't taking a sedative.
Aside from those differences, the rest was the same as described above.
I did not have much relief from my ESI's though. The FJI seemed to help a little more, but didn't last long, probably less than a week. But because I did have some response, my doctor believes I might be a good candidate for nerve ablation at the facet joint. So, I have an appointment to have a facet nerve block done on Aug 12. She said they will do the block, wait 30 minutes and test to see if my pain goes away. If it does then they will schedule the nerve ablation.
I really hope it works. I'd like to break the pain.
Cathy
L4-5 Mild-moderate disc degeneration with dessication. Mild endplate osteophytic ridging, accompanying dorsal disc bulging, eccentric to right of midline - leading to minimal flattening of right ventral thecal sac. Mild right foraminal narrowing due to lateral component of disc bulge as well as very mild endplate osteophytic ridging.
L5-S1 Mild disc degeneration with dessication, minimal disc bulging. Mild left foraminal narrowing due to facet hypertrophy and endplate ridging.
You forgot this part!
Doctor: Ummm, sirry sir. But, as you can tell, ummmmm, I am having a bit of, ahhhhhhh, trouble getting the needle into the, ahhhh, ummmmm, joint.
Me: No #### ??!! If I could hit you right now I would!!
DISCLAIMER: I am not a doctor, surgeon, physicians assistant, nurse, pharmacist, pharmacist technician, physical therapist, chiropractor, biomedical engineer, dentist, dental hygienist, psychiatrist, psychologist, psychotherapist, dermatologist, herbalist, massage therapist, midwife, obstetrician, optometrist, paramedic, podiatrist, audiologist, or medical examiner. All of my posts are for entertainment purposes only.
Oh, that's terrible. I'm so sorry that happened to you.
Did he/she finally get it right? Did it help you?
Cathy
L4-5 Mild-moderate disc degeneration with dessication. Mild endplate osteophytic ridging, accompanying dorsal disc bulging, eccentric to right of midline - leading to minimal flattening of right ventral thecal sac. Mild right foraminal narrowing due to lateral component of disc bulge as well as very mild endplate osteophytic ridging.
L5-S1 Mild disc degeneration with dessication, minimal disc bulging. Mild left foraminal narrowing due to facet hypertrophy and endplate ridging.
It was the last two of four that did not go very well. The relief was less than two weeks. Now the pain level is about back to where it was pre-injection.
DISCLAIMER: I am not a doctor, surgeon, physicians assistant, nurse, pharmacist, pharmacist technician, physical therapist, chiropractor, biomedical engineer, dentist, dental hygienist, psychiatrist, psychologist, psychotherapist, dermatologist, herbalist, massage therapist, midwife, obstetrician, optometrist, paramedic, podiatrist, audiologist, or medical examiner. All of my posts are for entertainment purposes only.
My 4th injection has probably created the greatest results. I am still sore due to the spasm I had in my upper back during the procedure, but other than that my lower back is about 50% better than it was before- which is a HUGE improvement!!!
ESIs are probably the best thing to ever happen to me!
28 y/o, L5-S1 Herniation- L-ESI #1: 10/03/07, Cervical Facet Joint Injections C6-C7 and C7-T1: 01/03/08, T-ESI #2: 04/29/08, L-ESI #3: 07/18/08, Started Chiro w/ rehab 02/04/09, T-ESI #4: 02/11/09, C-ESI #5: 09/17/09
My Published Back Injury Articles:
http://www.ehow.com/how_2326493_epidural-steroid-injection-back-pain.htm...
http://www.ehow.com/how_2323277_stop-back-pain.html
My Motto: Taking life 1 day at a time. If 1 day is too much- I'll take it by the minute!
I had an ESI on July 3. It went pretty much the way Krazigirl said. I was very nervous beforehand, but the procedure was really not bad; I would call it somewhat uncomfortable. I had the sedative, but would have been fine without it.
I was almost completely pain-free for the next day or two.
Unfortunately the pain releif only lasted about a week, with the pain gradually creeping back after 3-4 days.
Grade II spondylolisthesis at L4/5 with stenosis and degenerative disc disease
Anterior/Posterior fusion with instrumentation and decompression, scheduled for August 4, 2008
DDD in cervical spine
I too have had both types of injections, facet and epidural... They never work for very long for me and my PM only uses them now when I am in a horrible crisis. Personally, its like holding some candy in front of a kid... letting them smell but not taste... I just dont get any long term relief from these. Seems like a big cost for little effect. Hardly worth the effort to go in and get the injections... frustrating to know Im not going to get more then a week out of it anyway... and my PM isn't willing or interested in trying anything more then this...
Looking for a bullet.
MrsWings
aka-Theresa