Epidural spinal injections are used for:
-contrast injection for CT myelogram
-injection of radionuclide for nuc med scans
-injection of chemo medication into spinal canal
-injection of steroid medication for pain management
-spinal stenosis
-disk herniation
-degenerative disc disease
The procedure is the same for each indication, the difference is what is being injected
Lumbar injection procedure
- patient is changed into a gown, pants off, but underwear can stay on, bra should come off if woman but for pain management injections they can keep it on
- the pt will lie prone on the table, with a small bolster under the lower abdomen to slightly straighten the lordotic curve of the lumbar spine
- a towel or blue pad is tucked into the underwear and then lowered to the level of the PSIS
- the radiologist may fluoro to see the condition of the spine and to decide the best point of entry before beginning the procedure
- the area is then prepped using surgical asepsis, draped and local anesthetic is injected under the skin
- under fluoro guidance the spinal needle is inserted into a shallow depth
- the tech will then rotate the C-arm under the table for a shoot through lateral
- under fluoro, the radiologist will confirm the location and advance the needle to the required but safe depth into the epidural space
- contrast is then injected to confirm the needle location
- a sample of CSF may be sent to the lab if required
For an epidural steroid injection, the steroid solution is ___
Injected
For a CT myelogram, the required amount of contrast is injected into the _____ space
Epidural
For chemo or nuc med scans additional precautions are taken
- chemo drugs are very toxic and require special handling and disposal
- radionuclides also require special handling and be brought in a special lead holder and syringe to protect the staff
Following the injection, the pt is transferred onto a stretcher and must remain for _____ minutes depending on site protocol
15-30 min
- steroid pts may have the head of the stretcher raised
- CT myelogram pts must remain supine to prevent contrast from travelling up the spinal canal before their exam
- these are timed so the pt can have their CT done quickly after injection
Lumbar puncture needle placement and injection process
- Skin prep
- Lumbar puncture (done prone)
- CSF sample collected
- Contrast medium instilled
- Needle removed
Facet injections (zygapophyseal joint)
- injection of a local anesthetic directly into the facet joint(s) causing the pain
- steroid sometimes is also injected into the joint
- provides immediate pain relief if the facet joint is the cause of the back pain
Facet injections
- patient will be placed in either RAO or LAO position
- the facet joints are localized under fluoro
- the skin is prepped and draped
- local freezing is injected into the skin
- a spinal needle is directed toward the facet and a small amount of contrast is injected to confirm location
- the joint anesthetic and steroid are injected into the joint
- often more than the one level will be treated at the same time ex L1-L3 facets
Medial branch block
- each facet joint is connected to 2 small medial nerves that send pain signals to the brain
- MBB is often performed if facet injections have been performed but not resulted in long term pain relief
- if the MBB is successful the patient will have immediate pain relief
- (It lasts longer because they are actually freezing the nerve, lasts longer than facet injections)
Medial branch block procedure
- the procedure is similar to the facet joint in terms of positioning etc
- the skin is prepped and draped and local freezing injected
- under fluoro, the radiologist localizes the medial branch nerve area with a very small needle
- contrast is injected to confirm location of the nerves
- anesthetic is then slowly injected onto the nerves
- a positive result is no pain with movements that previously caused discomfort
- temporary (approx 24 hours)
