At any one point in time, 1% of America is suffering sciatica from a herniated disc. If that seems like a small number, consider that amounts to over 3 million people with burning, searing pain going down one of their legs right now!
Sciatica pain can be extremely painful, and it may burn or cause a pins and needles sensation along with muscle spasms. Patients may be administrated narcotic medications to treat pain, but they actually do not work so great for sciatica type pain.
But lumbar epidural injections actually have an excellent track record for sciatica. The principal behind an epidural steroid injection into the lower back is as follows. You have a nerve root that has been inflamed. This may be from a herniated disc, or in the case of spinal stenosis it may be overgrown and arthritic bone and soft tissue. There is another scenario where the disc may have a tear in it and that is sparking up what is known as a "chemical" radiculitis.
There are a few different types of lumbar epidural injections.
Intra-Laminar Epidural Injections
· Transforaminal Epidural Injections
· Caudal Epidural Injections
The first type invented sixty years ago was intra-laminar epidurals. These involve placing a needle just underneath the bony area overlying the spinal canal called the lamina. Thousand of intra-laminar epidural injections are done every day in America.
For decades, doctors did these injections in an office setting without an x-ray machine. Then a study approximately ten years ago showed that without a real time form of x-ray, called fluoroscopy, about 40% of these injections missed the mark. More and more, fluoroscopy is now becoming the standard of care in this country to ensure the best chance of accurate needle placement in epidural injections.
As the use of fluoroscopy was becoming popular, transforaminal epidural steroid injections were developed. These injections involve placing the steroid medication closer to the area of where the nerve roots are leaving the spinal and being pinched. This type of injection is now extremely popular among pain management doctors and the results have exhibited between 75% and 90% pain relief success in multiple studies.
The third type of lumbar epidural injection is termed a caudal injection. This injection is very interesting, as it involves an approach through a low point in the sacrum in the buttock area. The pain doctor places the needle through an area called the sacral hiatus and then injects a reasonable amount of numbing medicine and steroid. Multiple areas of nerve root compression can be evaluated at one time, which is great in a situation such as spinal stenosis that affects multiple levels.
Complications of epidural steroid injections are small but real. They may include infection, bleeding, and temporary nerve injury. Paralysis is an extremely rare complication.
These injections are done in an outpatient setting. Patients either receive intravenous sedation or simply local numbing medicine. For most patients that is all they need!