IR( interventional radiology)-11

Epidural Steroid injection:-

What is an epidural steroid injection?

An epidural steroid injection is a common procedure to treat spinal nerve irritation that causes chronic low back pain and/or leg pain (radicular pain). Disc herniation is also treated with epidural steroid injections. Epidural injections are also used to treat nerve compression in the neck (cervical radiculopathy). The procedure is quick and simple.

                           Drawing of a disc herniation compressing the spinal nerve root.


An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.

How is an epidural steroid injection performed?

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterward: "Is that all?"
The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of "durable"). The Greek word "epi" means "outside of." So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

[Epidural steroid injection with injection needle visible in the epidural space using a fluoroscope)

Region	Surgical	Image guidance	S&I
Cervical / Thoracic	62320	62321	77003/77012/76942
Lumbar/ Sacral	62322	62323	77003/77012/76942

Region

Surgical

Image guidance

S&I

Cervical / Thoracic

62320

62321

77003/77012/76942

Lumbar/ Sacral

62322

62323

77003/77012/76942

(Do not report 62321,62323 in conjunction with 77003, 77012,76942)

Sample Report:

1-REASON: c-spine injection

P 77002 FL GUIDE NDL PLACE

RESULT: Left radiculopathy

Under sterile precautions and using CT guidance, a 24-gauge needle was inserted into the epidural space at the C6-C7 intervertebral space. Once the position of the needle was insure in the epidural space 80 mg of methylprednisolone was injected into the epidural space at the level of C6-C7. The patient tolerated the procedure well. No complications occurred

IMPRESSION: Successful epidural injection of methylprednisone into the cervical spine.

2-LUMBAR ESI UNDER FLUOROSCOPIC GUIDANCE

INDICATION: Herniated disc.

COMPARISON: None.

TECHNIQUE: Following the acquisition of informed consent, the patient was placed in the prone position on the table and site selected over the L4-5 interlaminar space for appropriate ESI to follow under fluoroscopic guidance. A mark was placed on the patient's skin with an indelible marker and the patient was prepped and draped in a sterile fashion. Thereafter, 1% lidocaine solution was utilized for local anesthetic effect. A 20-gauge Chiba needle was advanced into the epidural space without difficulty. Epidurogram was performed with an injection of 0.3 ml of Isovue-300. This revealed a normal-appearing epidurogram. Thereafter, 120 mg of Depo- Medrol mixed with 1.5 mL of 0.25% bupivacaine and 0.5 mL of sterile saline. This was injected without difficulty. At the conclusion of the procedure, the needle was withdrawn and pressure was held on the site until all appreciable bleeding subsided. A bandage was placed on the site. The patient left the department in good condition.

IMPRESSION: 1. Successful lumbar ESI at L4-5. 2. This is the patient's first injection in this series.

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