I have an urgent question, I have an approx. 4 mm chiari herniation (confirmed by chiari specialist that review my mri, symptoms, etc) I also have increased csf pressure in head and many severe symptoms - I am still waiting to get actual appt. with the cm specialist as it is quite a distance for me and very hard to travel due to spinal issues and pain.
So back to my question - My pain specialist had me get a lumbar mri a couple weeks ago for progressing pain in my low back, leg and hip. Their office just called and said I have nerve compression on L4 & L5 so they want to do epidural steroid injections for that.
I am very concerned as I have been told by others that no epidural injections should be done with a chiari herniation due to the severe risk of csf leak suddenly pulling herniation down (or something like that) which would be very dangerous.
And my CM is very symptomatic with possible crowding of the structures also. And it already worsened within the last year along with the problems the High CSF in head is causing.
Can anyone give me any info. or advice on if the lumbar epidural injection would be safe or possibly too risky?
I really appreciate any info or advice on this, I am scheduled for the injection in a week and very worried.
I'm not a doctor, but this is my experience with your situation:
Both pre- and post-decompression surgery I have had epidural steroid injections in my lower lumbar spine. I find them to be very helpful with the nerve pain from my disc problems. The Orthopedic Surgeon who does my shots says that it is ok for me to get shots at the nerve root (targeted shots to the side of your spine) because the needle does not go near the spinal cord, therefore there are no problems with CSF leaks or adding pressure to your Chiari herniation. He will NOT do a caudal injection on me (where the needle goes up the base of your spine and gives a larger, general wash of medication) because the larger amount of medication can put pressure on the cord.
Anatomically, your spinal cord stops before where you have problems at L4-L5. The biggest worry with "pulling the herniation down" is from a procedure that specifically enters the cord, such as a lumbar puncture.
Be very clear with your doctor what kind of shot(s) you are getting. As I said, my docs have always said targeted (side) shots are ok and caudal (general) shots are not. I have had both (before my diagnosis) and I'll tell you that the targeted shots also hurt a lot less than the general one, so that's a bonus.
You usually have the option of requesting a calming medication from your doctor beforehand. Some places do IV meds during the procedure, some have you bring the pills your doctor prescribed you. You need to be awake, but if you will be at all nervous, the medication can relax you enough to make it a better experience.
If you have any more questions, let me know - I've had 6 or 7 rounds of steroid shots now : )
Just thought of another something that might help you-
You said that you were told you "have nerve compression on L4 & L5." What that means is that the disc between your L4 and L5 vertebrae are compressed. This means that you should have nerve pain in the areas of the body that correspond to your L4 and L5 nerves. In order to get the nerve root shots that you want, it would be really helpful if you brought with you a diagram of where your pain is so the doctor can decide where to give you shots (do you only have pain from the L5 nerve? Do you have pain from both nerves but just in your left leg? etc). I like drawing on a dermatome map like this one, so I can visualize which nerve is the culprit:
Also know that you will feel great right away after the shots because of the local anesthetic, but after that wears off you will be a little sore for a day or two. It takes two weeks for the steroids to reach their full effect. Don't be freaked out if you get some side effects from the steroids like hot flashes, they will pass quickly. Also, the shots will help with the nerve pain, but don't expect them to do much for the local pain around your spine. Ask for physical therapy for that if you can get it.
Sorry if this is too much information - I just wish that somebody had told me all of this stuff before I had my first shots, so I am passing the knowledge on to you!