This injection, generally performed as an outpatient procedure under local anesthesia, relieves low back and leg pain most often caused by scarring from a prior back surgery. The procedure is performed with the patient lying face down with a cushion placed under the stomach.
The physician locates the small opening at the base of the sacrum (called the sacral hiatus) and injects a local anesthetic that numbs the skin and all the tissue down to the surface of the sacral hiatus. The physician then guides the needle through the anesthetized track and into the epidural space. A contrast solution is injected, allowing the physician to see the scarred and painful areas on an X-ray device called a fluoroscope. A small, flexible catheter is fed through the needle and positioned at the location of scarring. A steroid-anesthetics mix is injected through the catheter and around the scarring, bathing the painful area in medication and dissolving the scar tissue. The needle and catheter are removed. In some cases, it may be necessary to keep the catheter in place to allow for more injections over the next few days. It also may be necessary to repeat the procedure a few months later to reduce scar tissue further.