Fun with big long needles

After a year, five months, and 11 days, my spine doc finally talked me into an epidural steroid injection. Well, two of them, actually.

I’d had one before, in my neck, in October 2006.  That one didn’t go so well.  While it did significantly help my shoulder pain in the long run, I had intense pain at the injection site for about 3 weeks.  Vicodin did nothing and they finally put me on Lyrica, a central nervous system depressant.  So, while that was all very exciting, it didn’t make me really enthusiastic to have another epidural.

Finally, though, this back pain wore me down.  I saw my spine doc last week and we went through everything I’ve already tried in the past year and a half, in addition to the things I haven’t tried (a very short list).  As I’ve mentioned before , my spine doc is big on injections, and once more he tried to convince me that just because I’d had one bad experience didn’t mean it would happen again….and, besides, the procedure for the lumbar spine is different than that for the cervical spine.  And double besides, even if the injection did hurt, I’d have a sore back and wouldn’t be able to skate or ride my motorcycle….and the whole reason I was at his office was because I had a sore back and wasn’t able to skate or ride my motorcycle.  OK, touché.

As with the cervical spine epidural, Peter trotted me over to Menlo Park Surgical Hospital, where I was fitted with a lovely surgical gown, booties, and hair net.   John the nurse hooked me up with a saline drip IV and took preliminary vitals.

Peter and I loitered about for quite some time as my spine doc was running a little late with his previous injection patient.  At one point, he and the nurse came in to slow down my saline bag since I was going through it too fast given the delay.  “We wouldn’t want to give you CHF over an epidural!”, they laughed, and then immediately learned why one shouldn’t make jokes like that to someone with health anxiety.  It took about 20 minutes, but Peter eventually talked me down off the ledge and things returned to relative normalcy.

The procedure itself was pretty similar to my last epidural.  I laid face down on a padded table with a head rest (“Just like a massage table! Only, uh, with no massage,” said the nurse). They prepped my back, attached a blood pressure monitor/pulse oximeter/EKG sensors, made sure I was OK with George Michael playing on the CD player, positioned the flouroscope, and got to work.

Once again, the most painful part was the local anesthetic injection.  That burns like you wouldn’t believe.  I said bad words.

Positioning the needles took the longest amount of time but was relatively painless.  There were a few moments of intense dull pain — kind of like a really bad, really deep huge muscle knot — but otherwise uneventful.

Here’s a side view from the flouroscope.  The horizontal lines are the needles; the squares they point at are the L4 (top) and L5 (bottom) vertebrae. The disc in between these two vertebrae is the one that ruptured.

Once the needles are in place, they take a bazillion photos with the flouroscope and then inject contrast dye.  This shows the doc where the medication will actually go, to make sure it’s all going to the right place.  He said this part might hurt; I didn’t feel anything at all on the first injection site, but the second one was a bit painful.  It hurt at exactly the same spot that my back has been hurting, which the doc said was a very good sign because that meant the medication would go right to where the pain was.

Here’s a back-to-front view — the black blotches coming off the needles are the contrast dye.

After that, they inject the medication, which was painless.  There was no awful crunching-cartilege sound this time…in fact, everything was coming in from the side inside of directly at my spine, so it was a lot more comfortable.

And that was pretty much that — they cleaned off my back, unhooked the sensors and IVs, rolled me onto a gurney, and off to the recovery room with me.

The nurse gave me apple juice and graham crackers, which was awesome since I hadn’t eaten in 18 hours, and rechecked all my vital signs.  My left leg was cold and tingly for about 10 minutes, and it was a little weak to stand on for my first few steps, but otherwise everything was good. After about 20 minutes, the nurse and Peter helped me get dressed and we were on our way.

And here’s the aftermath — two bandaids! :D I’m posting it since most people don’t really know where the L4 and L5 vertebrae are on the body.  The L5 is the bottom-most lumbar vertebra; below it are the five sacral vertebrae that are fused together to form the sacrum.

I’ve been staring at these kinds of diagrams for 17 months, but here’s some reference:

The injections today went into the epidural space that surrounds the spinal cord.

About an hour after the procedure, my back stiffened up and I was in quite a lot of pain.  Not anything worse than the worst of my injury flare ups, but enough that it was very difficult to walk and I was getting strange looks from people at the pizza place we stopped at.  Once I got home, iced my back, popped ibuprofen, and got into my zero-gravity chair, things calmed down.

Other than some anxiety last night, I’m doing pretty well. I slept well last night and am very sore today but nothing horrible.  I have a slightly elevated heart rate (100-120bpm), which the doc said is a normal reaction to the steroid and should resolve within a day or so.  I’m to take it very easy throughout the weekend — thank goodness for streaming Netflix and my recliner — and gradually increase activity next week.  I can see Melinda for physical therapy on Thursday if I’m up to it.  I see my spine doc for a check up in two weeks, and we’ll see where we go from there!