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.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.
The ‘Two-Pin’ technique increases sanitation for multiple dose vial users. They draw with the first pin, and then shoot/inject into the body with a new one. This procedure prevents any residual contaminants that may have remained on the drawing pin from being transferred into the body via the injection site. It also makes injection less painful since the drawing needle is necessarily dulled during passage through the rubber stopper atop the vial. A dulled needle increases injection pain because it doesn’t pierce the body as cleanly as an unused one. The protocol below is followed by AAS users who draw from multiple dose vials, but steps 4 - 8 are routinely disregarded by those users who draw from ampoules (also called ampules) and sachets.