What is an epidural?

This procedure is named after the space into which the medicines are injected. The epidural space surrounds the spinal fluid space. The nerves, after leaving the spinal cord, have to cross the epidural space on their way to the legs. The epidural space is normally empty, but is an ideal location to introduce medications that can act upon nerves.

 

What are the indications for a cervical epidural?

Irritated, pinched or trapped nerves running to the arm certainly can benefit from epidurals. Controversy surrounds the selection of a conventional epidural vs. a transforaminal epidural. Dr. Harries will discuss the relative benefits and risks of each procedure with you.

How is the procedure performed?

You will lie face down on an X-ray table and be made as comfortable as possible. Dr. Harries will then use an X-ray machine to identify where the epidural is to be performed. Your skin will be numbed and then to procedure needle itself will be placed using X-ray guidance in the correct position. Some X-ray dye will be introduced to confirm that the needle is in the epidural space. The medications will then be injected.

What about X-ray?

If epidurals are performed "blind", that is without the use of X-ray have been shown to end up in the wrong place 60% of the time even in expert hands. Additionally the spinal cord is very near to the epidural space. Using X-ray allows the physician to see where he is theoretically making this a safer procedure.

Can I be sedated?

Sedation significantly increases the risks of cervical epidurals. If a patient is awake, they are able to warn the physician of any peculiar sensations that would suggest that the procedure should be discontinued to prevent complications.

When can I drive?

You should not drive or operate machinery for at least 24 hours.

How long does it take for the epidural to take effect?

Steroid takes approximately three days to start working. For safety reasons Dr. Harries does not inject local anesthetic into the epidural space in the neck.

What are the risks associated with an epidural?

Complications after an epidural are rare. Steroids can result in an increased blood sugar particularly in diabetics. Infection is very uncommon particularly in non diabetics. Bleeding in to the epidural space is also very uncommon but a potentially serious complication. For this reason we do not perform an epidural on a patient taking blood thinners such as Coumadin, Plavix or Aspirin. Injury to the spinal cord is extremely rare, the risks are however increased when a patient moves during the procedure or is sedated for the procedure. If you feel that you are too anxious to have an epidural without sedation, then you are probably better off not having an epidural.