Spinal epidural injections happen to be a formidable treatment for individuals suffering from spinal nerve irritation, which is also termed radiculitis.
The interventions work great for helping with leg pain resulting from herniated disks along with the different types of spinal stenosis including lateral, central, and foraminal stenosis. Epidural steroid injections can also work extremely well for leg pain resulting from disk problems. Do epidural injections also help with back pain? They can, but usually they are best for leg pain issues.
Steroid spinal injections are really meant to get patients "over the hump". Steroids put "water on the fire" so to speak, allowing patients into rehab more comfortably and hopefully work and play with their kids and socialize. The steroids don't fix anything but they can temporarily do well with pain control.
Until we come up with something better, predominantly steroids are injected. How do they work?
They work by stabilizing neural membranes in addition to blocking phospholipase A2 activity, and reducing neural peptide creation.
Local anesthetics by themselves have been shown to produce a prolonged dampening effect of the dorsal horn and c-fiber activity. This may provide excellent pain relief by themselves without steroids.
C-arm guidance (called fluoroscopy) is currently the standard of care with epidural steroids. Numerous research studies have shown up to a 35% misplacement of the needle without it.
Here are the different types of injections along with some facts on each:
1. Caudal epidural steroid injections - indications are in individuals when it's difficult to accomplish the other approaches with transforaminal or intralaminar injections. Usually done in a post-surgical individual when transforaminal technique is too difficult or impossible. There are also reasons to perform a caudal injection in a patient with pelvic pain. These injections are the least technically demanding of the three. The miss-rate without fluoroscopy for caudal epidurals is 40% according to the literature.
2. Interlaminar Steroid Injections - This injection type allows for administration of steroid to higher lumbar areas. One of the downsides to the interlaminar injection is a significant incidence (5%) of dural tears which may lead to post dural puncture headaches. Advantages include being technically easy. It does necessitate pain doctors being familiar with the "loss of resistance" technique. It also allows for delivery of medication to areas higher in the spine than the caudal route. Research shows 30% misplacement without fluoroscopy, and this is a disservice to the patient.
3. Transforaminal epidural - The indication for a transforaminal is for radiculitis, with the reason being delivering the drug in highest concentration and closer to the site of the problem. There are numerous research studies showing the efficacy. These injections are the most demanding technically, and there is a mild risk of direct nerve trauma. A study in 1997 showed that these injections may take away the need for surgery. There was a 46% incidence of giving complete pain relief. Multiple studies have displayed approximately a 67% of patients being able to avoid surgery with these injections. A 2010 study by Bogduk et al was a randomized blinded prospective study evaluating transforaminal epidurals with steroid plus anesthetic, versus anesthetic alone versus saline in the epidural space. Well over 50% of patients received over 50% pain relief for the epidural injection with steroid and lidocaine and 25% of the people ended up completely pain free. The other groups achieved between 7% and 21% pain relief, so much less.
The interventions work great for helping with leg pain resulting from herniated disks along with the different types of spinal stenosis including lateral, central, and foraminal stenosis. Epidural steroid injections can also work extremely well for leg pain resulting from disk problems. Do epidural injections also help with back pain? They can, but usually they are best for leg pain issues.
Steroid spinal injections are really meant to get patients "over the hump". Steroids put "water on the fire" so to speak, allowing patients into rehab more comfortably and hopefully work and play with their kids and socialize. The steroids don't fix anything but they can temporarily do well with pain control.
Until we come up with something better, predominantly steroids are injected. How do they work?
They work by stabilizing neural membranes in addition to blocking phospholipase A2 activity, and reducing neural peptide creation.
Local anesthetics by themselves have been shown to produce a prolonged dampening effect of the dorsal horn and c-fiber activity. This may provide excellent pain relief by themselves without steroids.
C-arm guidance (called fluoroscopy) is currently the standard of care with epidural steroids. Numerous research studies have shown up to a 35% misplacement of the needle without it.
Here are the different types of injections along with some facts on each:
1. Caudal epidural steroid injections - indications are in individuals when it's difficult to accomplish the other approaches with transforaminal or intralaminar injections. Usually done in a post-surgical individual when transforaminal technique is too difficult or impossible. There are also reasons to perform a caudal injection in a patient with pelvic pain. These injections are the least technically demanding of the three. The miss-rate without fluoroscopy for caudal epidurals is 40% according to the literature.
2. Interlaminar Steroid Injections - This injection type allows for administration of steroid to higher lumbar areas. One of the downsides to the interlaminar injection is a significant incidence (5%) of dural tears which may lead to post dural puncture headaches. Advantages include being technically easy. It does necessitate pain doctors being familiar with the "loss of resistance" technique. It also allows for delivery of medication to areas higher in the spine than the caudal route. Research shows 30% misplacement without fluoroscopy, and this is a disservice to the patient.
3. Transforaminal epidural - The indication for a transforaminal is for radiculitis, with the reason being delivering the drug in highest concentration and closer to the site of the problem. There are numerous research studies showing the efficacy. These injections are the most demanding technically, and there is a mild risk of direct nerve trauma. A study in 1997 showed that these injections may take away the need for surgery. There was a 46% incidence of giving complete pain relief. Multiple studies have displayed approximately a 67% of patients being able to avoid surgery with these injections. A 2010 study by Bogduk et al was a randomized blinded prospective study evaluating transforaminal epidurals with steroid plus anesthetic, versus anesthetic alone versus saline in the epidural space. Well over 50% of patients received over 50% pain relief for the epidural injection with steroid and lidocaine and 25% of the people ended up completely pain free. The other groups achieved between 7% and 21% pain relief, so much less.
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Want to find out more about spinal epidural injections, then visit Preferred Pain Center's site on how to choose the best Arizona Pain Doctor for your needs.
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