Epidurals and nerve damage
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Side effects and adverse reactions with epidural steroid injections (ESI) are rare.
A dural puncture, or wet tap, is perhaps the most common complication from an ESI. This complication only occurs in 0.1 to 5 percent of all injections. This results of in a spinal headache and nausea. The headache occurs when the puncture in the spinal sac fails to seal itself off. Spinal fluid continues to leak out and lowers the spinal fluid pressure in the brain. This causes traction or pulling on the dura.
To treat a spinal headache, a "blood patch" is usually recommended. A blood patch is procedure where three ounces of blood are drawn from a vein. The blood is then injected into the epidural space. The blood clots around the spinal sac and stops the leak by forming a "patch".
There is a small chance that the medication may be injected into one of the small blood vessels that run through the epidural space instead of the epidural space itself. This can cause seizures, cardiac arrest, and even death if too much of the medication goes directly into the blood steam. The chance of this happening is low and careful techniques prevents this.
Epidural injections are done under sterile conditions. Nonetheless, anytime a needle is inserted into the body there is a small chance of infection.
An epidural injection can result in a hematoma. A hematoma is a collection of blood. An epidural hematoma can be serious if it is big enough to cause enough pressure on the spinal nerves. This can cause problems with the bowels and bladder.
Because the epidural injection actually paralyzes the nerves to the bowel and bladder for a short period, loss of control over the bladder can occur for one to two hours.
There is always a small risk of damage to the spinal nerves. The spinal cord is a bundle of nerves that connects the brain with the rest of the body. If the epidural needle directly injures the spinal nerves, this can cause neurologic problems.
This is more of a problem with epidural injections in the neck and thoracic region than the low back because the spinal cord ends at a level much higher than low back epidural injections are administered.
One complication of epidural injections regardless of where they are done is arachnoiditis. This is an uncommon but serious and painful chronic inflammation of nerve roots. The cause is still largely unknown and the treatment eventually requires narcotic analgesics for control of pain.
Epidural injections should be administered using either ultrasound or fluoroscopy for needle guidance.
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