Different Types of Epidurals

Orthopaedic & Spine Center

An Overview of the Different Types of Epidural Injection Used for Interventional Pain Management

Did you know that there are different types of epidural steroid injections? Everyone thinks of an epidural as the procedure you have to relieve pain and make you go numb before having a baby. But, this kind of epidural is different from the steroid epidural that is done, either within the cervical or the lumbar spine, and which provides long term pain relief.

First of all, you should only seek care from a skilled physician who has experience in providing epidural injections. At OSC, Dr. Mark McFarland, a fellowship-trained spine specialist does them in the lumbar spine, as do the two Interventional Pain Management Specialists (Dr Jenny Andrus & Dr Raj Sureja), who do cervical and lumbar. The facility where your epidural is being performed should use fluoroscopy (a special X-ray using dye) to make sure your epidural is being done in the right place and that it is not being done “blindly”. At OSC, we have two state-of-the-art “C ARM” fluoroscopy machines. They are called “C Arms” because they look like a great big letter “C”.

It should be noted that an epidural does not penetrate into the spinal cord, the vertebral bone or into the spinal nerves. The physician will look for the epidural space, near the nerve that is inflamed and will place the medication near the nerve itself. At no time should the needle ever enter the spinal cord. Sometimes patients believe this to be true and it frightens them away from having an epidural.

You can get an epidural in your cervical spine (neck) or in your lumbar spine (lower back). The cervical epidural is used for pain that is caused by some kind of problem in the cervical spine, like a disc herniation or spinal stenosis. However, the pain can be felt in the neck, head, shoulder, or arm. The lumbar epidural is for problems with the lumbar spine, characterized by pain in the lower back, buttock or leg. Cervical Epidurals usually provide pain relief for patients anywhere from a few months to several years. Lumbar epidurals typically do not last quite as long and can provide pain relief for up to a year in most cases.

Intralaminar Epidurals are most commonly performed and involve the injection happening in the middle or mid-line area of the spine. Sometimes this approach works well and provides pain relief. In cases where the nerves along the side of the spine are inflamed or where there are discs that are herniated to either side, a Transforaminal Epidural may be best. These Epidurals are done with a more diagonal or side approach so that the affected nerve(s) and or disc can be better treated.

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