Brief Answer:
Safety concerns between venues minimal if OPERATOR is experienced

Detailed Answer:
Good morning and many thanks for your direct query regarding the use of epidurals and your very reasonable question of safety of injections based upon professional venue where applied.

I am a very strong advocate for my patients when it comes to full and complete relief when it comes to chronic back pain related to pathologies such as what you possess. However, I also caution patients of the inherent risks of the use of epidural injections as in some cases they are overused and can even place a person at risk of increasing long term pain and discomfort which then, becomes even more exacerbated by the same injections and a vicious circle becomes formed.

A good operator will always apply the injections (no matter venue) with care and expertise independent of location and if it is safety that is your utmost concern then, a good operator will have all the necessary precautions and safeguards in place so that in case of emergency all personnel are well trained and a protocol will be in place to make sure all patients receive the utmost attention.

If you are someone who has special needs such as a respiratory illness that can be easily decompensated or a metabolic condition which can undergo rapid changes such as brittle diabetes or severe and difficult to control hypertension then, perhaps a surgical center could edge out an office setting in terms of rapid access to IV solutions and more robust pharmacy for resuscitation purposes if certain medications are needed to stabilize blood pressure, sugar, etc. But then, again, a good office setting could just as easily stock such medications in its own physical plant and hire qualified nurses to set up proper IV's in case of such emergencies without being in a surgical center. I've set up patients for infusions and other procedures with such contingencies in place and have never had complications.

The risk of injecting steroid or anesthetic into an area that is NOT the epidural space could cause some prolonged anesthesia of the lower extremities or one extremity depending upon location injected. It could cause an anaphylactic reaction (allergic reaction) if the patient were hypersensitive or allergic to any of the components of the medications placed in the space. Contrary to popular concerns, epidural injections do not puncture the spinal cord even if given without fluoroscopic guidance since the anatomy of the spinal column and placement of the cord BEHIND thick bony vertebrae make it physically impossible for needles to penetrate no matter how long. It is certainly possible that injection needles can inject directly into NERVE ROOTS that emanate from the cord but this is not the same as puncturing the cord itself. Also, at the level of L4/L5 where your injection will be placed the spinal cord has long since terminated and is not even present if if the injection needle were placed virtually all the way through the thecal sac into the CSF space.

Other more common complications of such injections (no matter what type of center applies the injection) is what is referred to as a CSF puncture leak which would result in loss of cerebrospinal fluid. Most of the time this complication will resolve itself with rest, compression over the injection site, and fluid hydration. In some cases a blood patch may need to be applied which is a simple and quick procedure which can be done in an office or surgical center setting with the same ease for an experienced and well trained operator.

I hope these perspectives are of help in your decision-making process to choose either an office or surgical center setting and I believe the more important factor in this process is:

1. Choosing a doctor of experience and confidence who has good contingency plans and properly trained personnel to implement these plans in case of need

2. Recognition by both patients and doctors that the use of frequent injections in the control of such pain can itself lead to increasing long term pain frequency and responsiveness to such treatments since the chemical compounds in these injections themselves can cause deterioration of tendons, ligaments, and muscle tissue necessary to keep the spinal column well buttressed and minimize risks of disk compressions/herniations.

I personally recommend patients not use more than 2 injections yearly and resort to them only when all conservative measures for pain management have failed (i.e. physical therapy, kinesiotherapy, aquatherapy, back exercises, TENS unit, THERMAZONE thermal intervention, acupuncture, appropriate analgesics).

If I've satisfactorily responded to your concerns would you please do me the great favor of CLOSING THE QUERY and rating my response with a 5 STAR RATING along with POSITIVE FEEDBACK. I look forward to further questions you may have in this or other areas and once again appreciate your direct query of my service.

This question has required 35 min. of professional time in the review, research, and presentation of a full response to the query.

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