Individuals who are doing with chronic sciatica often end up undergoing epidural steroid shots for pain relief. There are actually 3 different types of epidural steroid injections that people may undergo.
All 3 of these epidural steroid injection methods work by decreasing swelling and inflammation of the nerve roots in the space around the dural sac, which is known as the epidural space.
The 1st type of epidural injections that has been utilized for decades is an inter-laminar epidural injection. These used to be performed without x-ray guidance in the office by using simply feel.
Some doctors still perform them without x-ray guidance, however, it has been shown that without it 30% of the time the injection misses the epidural space. So most doctors in this day and age do use fluoroscopic guidance for placement.
In interlaminar steroid injection involves injecting material right over the dural sac. This becomes an inexact science as most of the time nerve compression is taking place farther out to one side or the other. So the injection material has quite a ways to go to reach the problem region.
This brings us to the 2nd type of epidural steroid injection, which is a trans-foraminal type of injection. This injection has become much more popular over last decade and allows injection doctors to place the steroid medication closer to the area of nerve root compression.
The cortisone injected can reduce swelling and inflammation around the pinched nerve with its hefty anti-inflammatory action. Medications that numb such as lidocaine are also often placed which can help disrupt the pain cycle with the steroid providing significant pain relief.
The 3rd variant of epidural injections is called a caudal injection with the needle being placed through the sacral hiatus and a large volume of both steroid and numbing medicine is then injected.
This is not an exact science and what pain doctors hope is that a large amount of steroid will make it to the problematic areas for those nerves being compressed. Some research does show that caudal injections can work really well for acute sciatica.
A new study out of Norway that was published by the Massachusetts medical Society looked at caudal epidural steroid injections for chronic sciatica. The study looked at injecting steroid versus simple saline in individuals with more than 12 weeks of chronic radiculopathy.
Individuals were followed for a whole year period at the end of the study half the patients reported feeling a lot better and only 27% continued to have radiculopathy pain.
The interesting point here is that there was not a significant difference between the control group versus the steroid group. Therefore the conclusion is that caudal epidural steroid injections were ineffective for chronic lumbar radiculopathy.
Therefore based on this study the better course of action would be to utilize one of the other epidural steroid injection types of chronic sciatica. This would mean either using the interlaminar or transforaminal varieties.
All 3 of these epidural steroid injection methods work by decreasing swelling and inflammation of the nerve roots in the space around the dural sac, which is known as the epidural space.
The 1st type of epidural injections that has been utilized for decades is an inter-laminar epidural injection. These used to be performed without x-ray guidance in the office by using simply feel.
Some doctors still perform them without x-ray guidance, however, it has been shown that without it 30% of the time the injection misses the epidural space. So most doctors in this day and age do use fluoroscopic guidance for placement.
In interlaminar steroid injection involves injecting material right over the dural sac. This becomes an inexact science as most of the time nerve compression is taking place farther out to one side or the other. So the injection material has quite a ways to go to reach the problem region.
This brings us to the 2nd type of epidural steroid injection, which is a trans-foraminal type of injection. This injection has become much more popular over last decade and allows injection doctors to place the steroid medication closer to the area of nerve root compression.
The cortisone injected can reduce swelling and inflammation around the pinched nerve with its hefty anti-inflammatory action. Medications that numb such as lidocaine are also often placed which can help disrupt the pain cycle with the steroid providing significant pain relief.
The 3rd variant of epidural injections is called a caudal injection with the needle being placed through the sacral hiatus and a large volume of both steroid and numbing medicine is then injected.
This is not an exact science and what pain doctors hope is that a large amount of steroid will make it to the problematic areas for those nerves being compressed. Some research does show that caudal injections can work really well for acute sciatica.
A new study out of Norway that was published by the Massachusetts medical Society looked at caudal epidural steroid injections for chronic sciatica. The study looked at injecting steroid versus simple saline in individuals with more than 12 weeks of chronic radiculopathy.
Individuals were followed for a whole year period at the end of the study half the patients reported feeling a lot better and only 27% continued to have radiculopathy pain.
The interesting point here is that there was not a significant difference between the control group versus the steroid group. Therefore the conclusion is that caudal epidural steroid injections were ineffective for chronic lumbar radiculopathy.
Therefore based on this study the better course of action would be to utilize one of the other epidural steroid injection types of chronic sciatica. This would mean either using the interlaminar or transforaminal varieties.
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