Epidural steroid injections for dogs

This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.  

Radiculopathy occurs when something irritates a spinal nerve—say a “slipped disc” causing a pinched nerve. This is also called sciatica . There are resident stem and other cells in the local tissues everywhere in our body. Many live around blood vessels. These are obviously also present in the disc and nerves in the epidural space and they usually play an important role in suppressing inflammation and repairing damage. We know, based on a copious in vitro (lab) data, that the high-dose steroids used in epidural injections can kill these cells. So the progression of the series of epidural steroid injections looks a little something like this:

The benefits from the first shot only lasted 2 weeks. The second and third set of injections lasted about 90 days. In November, I was ready to have surgery. My EMG and nerve conduction tests proved that the nerves were "sleeping" before I was. After another MRI, the neurosurgeon said I was a candidate for surgery but I was not able to get the endoscopic type surgery that is less invasive. I would have an incision about 6-8" long. Along with removing the herniation, they would have to increase the size of the hole where the nerve roots were going through.

Many people begin to notice meaningful pain relief within two to five days after an injection. If the treatment proves to be beneficial, its effects may last for one week up to one year. If necessary (and at the discretion of a physician), a patient can typically receive up to three injections during a one-year period. Any more than that, however, can increase the risk of side effects, such as osteoporosis (weakened bone tissue). That’s because cortisone can inhibit the body’s production of vitamin D, which in turn can interfere with the absorption of calcium that’s essential for strong bones.

Those patients who still have some residual pain after the first injection should receive a second and third injection and patients who did not get any benefit from the first injection should not receive another one. Patient selection is very important in deciding on the type of injections patients should receive. Transforaminal injections (different approach to the epidural space) may produce longer pain relief and may also predict whether a patient might benefit from surgery or not (for details, see review McLain et al, Spine Journal 2005). For patients with the diagnosis of lumbar canal stenosis, improvement after such injections may be longer lasting than it was initially thought (Kapural et al., 2005).

The steroid medication begins to take effect in one to two days at which point you should start to see some benefit. The steroid effect continues to get stronger and stronger such that the peak effect occurs at about two weeks. Thereafter, the effect will stabilize and should last several weeks to months. Typically, the pain relief experienced from this procedure lasts 3-6 months, but there is significant variability from patient to patient and from one procedure to another. If and when the pain starts to return, this procedure can be repeated to try and attain some pain relief once again. Keep in mind that this injection may work very well for pain certain areas but may not help with others. This is normal. Areas of pain that do not respond may need other treatments, which you can discuss with your doctor.

Epidural steroid injections for dogs

epidural steroid injections for dogs

Many people begin to notice meaningful pain relief within two to five days after an injection. If the treatment proves to be beneficial, its effects may last for one week up to one year. If necessary (and at the discretion of a physician), a patient can typically receive up to three injections during a one-year period. Any more than that, however, can increase the risk of side effects, such as osteoporosis (weakened bone tissue). That’s because cortisone can inhibit the body’s production of vitamin D, which in turn can interfere with the absorption of calcium that’s essential for strong bones.

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