Swab the area very well and slowly penetrate the 18g pin directly into the abscess. Keep pushing the pin in and gentaly aspirating every few millimeters until you hit the cyst. Slowly aspirate the cyst. You should be able to draw out the initial volume injected and then some blood and puss. You can expect to drain out 3ml from a 2ml injection 4-5 days post injection. This will give your immune system and the anti-biotics the best chance of fighting the infection. Always complete the course of anti-biotics even if the symptoms and swelling subside.
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.
We note these studies not to discourage you from undergoing epidural steroid injections, but rather to help foster well-rounded discussions with your doctor. These injections have been shown to provide excellent pain relief in many patients (particularly those who have had symptoms for less than 3 months, not had a previous spine surgery, are younger than 60 years, and don’t smoke). However, epidural steroid injections are not magic bullets. Before starting injection therapy, talk to your doctor about the specific risks and benefits for you.