The estimated frequency (number of instances per spinal or epidural injection) is: The chance of nerve injury is between one in 1,000 and one in 100,000. In many of these situations, the symptoms improve or disappear in a few of weeks or months. However, some patients may have long-term consequences such as pain, muscle weakness, or paralysis.
Patients who develop permanent nerve damage need to be treated by a neurologist. There are two types of permanent nerve damage: axon loss and demyelination. Axon loss can be caused by ischemia (lack of blood flow to an area of the body), compression, trauma, infection, autoimmune disease, or genetic conditions. It can also be due to toxicity from medications or chemicals. Patients with axon loss will gradually lose feeling and strength in the affected limb. Demyelination can be caused by multiple factors including infections with human T-lymphotropic virus type I or II, vitamin B12 deficiency, alcohol abuse, systemic lupus erythematosus, syphilis, or diabetes. It can also be due to the use of drugs such as chlorpromazine, cyclophosphamide, nitrous oxide, or propanolol. Patients with demyelination will experience problems with sensation and movement until new myelin forms which allows for regenerative repair.
Nerve damage is an uncommon side effect of a spinal or epidural injection. The majority of the time, a single nerve is damaged, resulting in numbness on the skin or restricted muscular weakness. These effects are generally transient, with complete recovery happening within a few days or weeks. But in rare cases, a large number of nerves may be affected, which can lead to permanent paralysis.
Spinal injections aim to relieve pain by delivering medication directly into the space around the spinal cord. Epidural injections are given directly into the space between the spine and the outer layer of tissue (the dura) that covers the brain and spinal cord. The epidural space contains many of the same nerves as the spinal column. So if you have been given an epidural injection, there is a chance that it could affect the nerves in your back.
Symptoms of nerve damage include pain during injection or after the procedure, muscle weakness, tingling sensations, and loss of feeling in your legs. If you experience any of these symptoms, contact your doctor immediately so that the problem can be resolved before further injury occurs.
Nerve injury is an uncommon side effect of spinal or epidural injections. Nerve injury is often only transient. Permanent nerve injury that results in paralysis (loss of function of one or more limbs) is extremely uncommon. Additional numbers are provided at the end of this section.
Studies have shown that the risk of developing permanent nerve damage due to a needle puncture is approximately 1 in 10,000 for epidurals and 1 in 250,000 for spinal injections. These figures should help patients understand that the risk of developing permanent nerve damage following these procedures is very low.
In addition to the extremely low rate of permanent injury, many studies have shown that most injuries recover within a few months if patients receive adequate treatment. In fact, many patients who develop temporary nerve damage from injections will experience complete recovery of sensation and muscle control within six months. However, since most patients do not seek medical attention until several weeks or months after the incident occurred, it's difficult to determine how many people are left with long-term effects.
The best way to prevent nerve injury is by using proper technique. If you don't use enough local anesthetic, you'll need to inject more deeply which increases your risk of hitting nerves. Also, make sure the tip of the needle is beveled in order to reduce the risk of causing nerve damage.
Frequency In the last 2-3 decades, the yearly incidence of spinal epidural abscess has increased from 0.2-1 cases per 10,000 hospital admissions to 2.5-5.1 instances per 10,000 admissions. This increase may be due to more effective treatment or just better detection because symptoms can be very nonspecific.
Spinal epidural abscess is a rare but serious infection that can spread through your body like a chain reaction. It starts in your spine and then spreads like a tumor to other parts of your body. If not treated properly, it could lead to death. About half of all people who develop an epidural abscess will die within two years, even with appropriate treatment. The other half makes a full recovery with medication and surgery.
Epidural abscesses usually arise after someone experiences pain when their back muscles are weakened by illness or injury. They most often occur in adults over 40 years old who have existing problems with their spines such as scoliosis (skewiness of the spine) or degenerative disc disease. Women are also more likely to suffer from spinal epidural abscess than men. Race does not seem to play a role in its occurrence.
The diagnosis of spinal epidural abscess requires that several conditions be met.
Nerves can be damaged by the needle or epidural tube, although this is unusual. Nerve injury can result in a lack of feeling or movement in your lower body. A tiny, numb patch with normal mobility and strength is the most prevalent symptom. This normally improves within a few days or weeks, although it might take months at times. If the injury is serious, you might require surgery to reconnect the nerves.
Anaesthetics can also cause nerve damage. Some people are more prone to nerve damage from anaesthetics than others. For example, if you have diabetes, you are more likely to develop nerve damage after having an operation where you receive an epidural anaesthetic. Other factors such as age, health problems, and type of procedure carried out are all important in determining your risk.
Nerve damage from epidurals or other anaesthetics is rare but it does happen. If you experience any pain or loss of movement in your legs after an epidural injection, get medical help immediately.
Dr. Andrus advised me that you may have many epidurals in a year safely, but no more than three or four. Too much steroid can be harmful, thus a smart doctor will keep track of how much steroid is given to a patient over a set length of time. The same thing applies to other medications a patient receives during surgery-the doctors should try to keep them at the lowest possible dose for the longest period of time possible.
In my case, I had five epidurals over the course of my two-day surgery. Dr. Andrus said that was enough for me because I was also given several other drugs during the procedure. He told me it was safe for me to receive so many treatments so close together because I was under general anesthesia the whole time.
General anesthesia keeps you asleep throughout your surgery. It prevents you from feeling any pain as well as discomfort from blood loss and the stretching of muscles during major operations. Doctors use a variety of drugs during general anesthesia to achieve these results. Most commonly, they use a combination of morphine and fentanyl to relieve pain and thiopental and succinylcholine to make you sleep.
Morphine is a strong opioid pain reliever used with bracing effects to treat moderate to severe pain. Fentanyl is a powerful analgesic (painkiller) derived from natural sources such as cotton seeds and nuts.
In most cases, a patient can have up to three epidurals in a row, no more than two weeks apart (but it is advisable to have as few epidurals as possible). If pain recurs, epidurals may be repeated every 6–12 months if necessary. Excessive use of epidurals can have serious consequences. Patients who receive an excessive number of epidurals often experience reduced sensation or loss of consciousness (anesthesia-induced sedation), which increases the risk of respiratory depression if more than one other drug is given at the same time.
Epidural blood patches are used in rare cases where multiple epidurals produce no effect. In these patients, the procedure uses blood extracted from another part of the body to fill the space between the membranes that cover the spinal cord and brain. This creates a temporary blockage of nerve signals so that pain can be reduced.
Patients should be warned that the effects of epidurals will wear off between doses. In fact, doctors usually recommend waiting at least six hours after an epidural before giving another one. But if pain persists after the second shot has worn off, then something else is going on. Possible causes include scarring of the nerves due to previous injuries, infections, or tumors; problems with the spine, neck, or back; and diseases such as diabetes or syphilis that affect the nervous system.
In some cases, physicians may suggest a neurostimulator instead.