Nonsurgical Treatment
Botox
Bracing for Adolescent Idiopathic Scoliosis
Discography and IDET (diagnostic as well)
Electromyography (EMG)
Epidural Corticosteroid Injection
Hip Arthrogram
Ice Therapy
MRI
Physical Therapy / Rehabilitation Exercises
Radiofrequency Abalation
Spinal Cord Stimulation
Trigger Points Injections
Epidural Corticosteroid Injection
Spine injection procedures have been employed in the management of patients with cervical,
lumbar, and radicular pain syndromes for almost a century. The first report of epidural steroid
injection was in 1951.
Corticosteroids are known to have strong anti-inflammatory properties.
Locally, corticosteroids act to inhibit the inflammatory response induced by mechanical,
chemical, or immunologic agents.
Epidural steroid injection is a term applying to a variety of techniques
performed to deliver a corticosteroid preparation into the
epidural and perineural spaces of the spine. Three routes may be used in the lumbosacral
spine: caudal, translaminar, and transforaminal epidural injections.
The translaminar injection offers a potential advantage of delivering solutions
directly into the epidural space and therefore closer to the source of pain, however, the
medication is placed away from the disc, without any guarantees that it
will flow to the front epidural space where the disc-nerve root pathology
is occurring. The transforaminal technique requires fluoroscopic guidance
for precise needle placement. This technique is favored by some, because of the precision
with which solutions can be delivered to a specific nerve root and the front location
of the needle in the epidural space. If fluoroscopy is not available, generally the caudal route
is preferable for disc pathology at the L5/S1 level and the translaminar route
for lesions above this level.
Several different steroid preparations may be used, with or without local anesthetic or normal
saline, to increase the volume and ensure the spread of medication to all areas causing pain.
The primary indication for an epidural steroid injection is the relief of pain due
to inflammation of the nerve elements in the epidural spaces of the spine, however,
the question of when an epidural steroid injection should be administered has not been thoroughly
studied. The decision on how often an epidural steroid injection should be administered is
also unknown.
There are few contraindications to performing lumbosacral epidural steroid injections: a
bleeding disorder, anticoagulation, and allergy to medications. Diabetes and congestive
heart failure require caution. The current use of aspirin or nonsteroidal
anti-inflammatory drugs is not an absolute contraindication, but most physicians
ask patients to stop seven days before the planned injection.
Complications are uncommon, and usually temporary and serious complications
are rare. Infections may be introduced by injection techniques. Inadvertent dural
puncture, which occurs in about 5% of translaminar and 0.6% of caudal injections,
may occur. A vasovagal reaction associated with deep pain of injection is
another complication associated with these injections. Intravenous injection
is also possible, but can be prevented using fluoroscopy. Last, the injection procedure may
not improve a patient's pain.
The whole point of using an injection is to place the medication as close
to the pathologic process as possible in order to gain the best therapeutic benefit. The
treatment is used to achieve a significant reduction in pain without the need for
surgery. More than a single injection may be required in any given patient.
Further information can be found at: http://www.spineuniverse.com/
