by Nevada Pain
The spine is composed of a column of vertebrae separated by intervertebral discs. The discs are flexible and allow the spine to move in different directions. A normal disc is composed of an inner semi-fluid material called the “nucleus pulposus.” It is surrounded by a fibrocartilaginous ring called the “annulus fibrosus.”
Repetitive stress such as bending and heavy lifting can cause tears in the outer ring of the disc. This allows the inner semi-liquid material to leak out of the confines of the disc.
When it does so, it irritates the adjacent spinal nerves. This leads to what is commonly called “a pinched nerve” or “sciatica” if it occurs in the lower back. If the outer ring (annulus) ruptures completely, the entire contents of the inner disc can protrude into the spinal canal.
This is called a “herniated” (ruptured or prolapsed) disc. The disc material that protrudes into the spinal canal frequently causes impingement of a spinal nerve. Irritation of a spinal nerve leads to pain down the arm (in the case of cervical disc disease) or down the leg (in lumbar disc disease).
Indications for epidural steroid injections
Initial treatment of a herniated disc consists of analgesics such as anti-inflammatory drugs (e.g., ibuprofen), a short period of bed rest followed by physical therapy. When nerve root irritation exists, corticosteroids can be used to suppress inflammation around the nerve roots and relieve pain.
Steroids inhibit the inflammatory response caused by chemical and mechanical sources of pain. Corticosteroids can be administered orally or directly around the affected nerves by means of an epidural steroid injection. Epidural steroid injections can be performed in the cervical or the lumbar spine.
Any spinal condition which causes nerve root irritation (“pinched nerve” or sciatica) may respond to epidural steroid injections including lumbar spinal stenosis, vertebral compression fractures and facet joint syndrome. Lumbar spinal stenosis is a condition where arthritic changes affect multiple areas of the spine leading to narrowing of the spinal canal and foramina (small openings through which the spinal nerves pass).
The facet joints are true diarthrodial joints (just like the knee or shoulder) located in the spine which are susceptible to arthritic degeneration which can lead to nerve root irritation. This condition is referred to as facet joint syndrome.
The spinal cord is suspended in cerebrospinal fluid and encased in three membranes. The outermost membrane is the toughest and is called the dura. Each spinal nerve exits the membrane-enclosed sac just below its corresponding vertebra. Thus, an “epi”-dural injection bathes the spinal nerve after it exits the outermost membrane.
The injection is performed with the aid of fluoroscopy which is an x-ray technique that allows the physician to visualize the placement of the needle. The injection is localized to the spinal level that is clinically suspected to be involved.
Injection of the corticosteroid medication in this way allows the use of a high dose for maximal anti-inflammatory action directed to the affected nerve root. The rest of the body is spared exposure to such a high dose.
Epidural steroid injections are typically limited to a series of three which can be repeated every few months. The results of epidural injections have been shown to be 75-90% good to excellent for pain relief. They often help Las Vegas pain management patients avoid surgery and get back to work, playing with the kids and socializing.
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