Epidural Pain Relief

Relieving Pain and Stress Relief

Introduction

Bleeding into the epidural space following surgery or leakage of disc material following breakage or a tear of a disc most commonly causes epidural scarring. Presumably, inflammation and compression of nerve roots by epidural scar (Adhesions) are the mechanism of persistent pain following back surgery, ruptured or herniated discs, or vertebral body fracture. Epidural scar may also contribute to the pain of spinal column metastatic carcinoma, failed facet joint syndrome, and unexplained neck or low back pain.

Diagnosis

Conventional studies such as myelograms, computerized tomography (CT Scans), and magnetic resonance imaging (MRI), are usually inadequate to make the diagnosis. Injection of contrast material (dye) into the epidural space yields an "epidurogram", which is diagnostic for the presence or absence of epidural scar tissue.

Procedures

Since further surgery would only produce more scar tissue, a different approach to the problem needs to be taken. "Lysis of Epidural Adhesions suing the Epidural Approach"(Breakage of scar tissue) is an alternative to this problem. The procedure consists of introducing an epidural catheter (thin plastic tube) into the epidural space (space between your spinal cord and the walls of the spinal canal, within your backbone). Once in place, medications are injected through this tubing in order to break the scar tissue. Although the catheter is placed within fifteen to twenty minutes, it is kept in the epidural space for approximately 3-4 days. During this time, the injection of medications through the tubing is performed on a daily basis, while at the same time the patient undergoes extensive physical therapy. At the end of the 3rd-4th day, the catheter is removed and the patient discharged to home.

Conditions

Usually Treated with This Modality Conditions include, but are not limited to:

  • Failed Back Surgery Syndrome
  • Back and leg pain
  • Neck and arm pain
  • Leg pain
  • Disc disruption
  • Traumatic vertebral body compression fracture
  • Degenerative arthritis of the spine
  • Facet pain
  • Epidural scarring following infection
  • Occipital neuralgia
  • Others

Side Effects and Possible Complications

Everything in medicine is subject to side effects and possible complications. No two patients are alike. Side effects and complications are not the same or equivalent to malpractice. Malpractice refers to an injury sustained by a patient, which occurs as a consequence of negligence in the practice of medicine. Side effects and complications, on the other hand, are unforseen events, which can occur and may injure a patient, in certain percentages of the population. These events can, and do occur even if everything goes according to plan, and in the absence of negligence or malpractice. Possible side effects and complications of this procedure include, but are not limited to.

  • Pain or worsening of symptoms
  • Infection (local = abscess; or generalized = sepsis), including meningitis and death. Infection due to a steroid-induced immune system suppression.
  • Bleeding, including hematomas, which might compress the spinal cord, therefore causing paralysis.
  • Nerve damage, including sensory or motor weakness, and/or paralysis. Nerve damage, ranging from minor nerve irritation with pain, to major nerve damage with paralysis, impotence, urinary incontinence, and/or fecal incontinence.
  • Allergic reactions ranging from a minor rush to an anaphylactic reaction and death
  • Failure to relieve pain
  • Spinal cord compression leading to paralysis
  • Breakage of catheter (tubing)
  • Unforeseen events

Guarantees That It Will Help

None. There are no guarantees in medicine.

Result of Treatment

93.9% of patients will experience some pain relief, which will be variable. 6.1% will experience no relief.

Duration of Results

Only 12.3% will experience persistent pain relief beyond 12 months. 57.9% of male patients and 64.4% of female patients will experience between 0-3 months of variable degrees of pain relief.