Tag Archives: epidural steroid injections

A Look at Epidural Injections for the Lumbar Spine

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One of the most common pain management procedures performed on a dSciatica Treatmentaily basis in America are lumbar epidural injections. They have been performed for over 60 years with many studies showing significant effectiveness for relieving pain from pinched nerves known as sciatica.

There are three popular methods of performing epidural steroid injections. All of these are performed as an outpatient, and in addition all involved numbing medicine plus cortisone to soothe the inflammatory reaction sparked up by the nerve root compression.

The first type of epidural is known as the interlaminar approach. This was the first type invented back in the 1950s, and involves an approach between the bones in the back of the spine known as the lamina. This approach has been shown to be very safe and effective, with pain relief occurring in approximately 75% of patients. Often times, a series of up to three injections may be necessary for optimal relief from the sciatica.

Pain Management Clinics PhoenixThe newest type of epidural injection is known as a transforaminal epidural steroid injection (TESI). This injection involves placing the needle closer to the actual area where the nerve root is being pinched. Nerve roots travel from the spinal canal through the area known as the foramen, therefore the transforaminal injection places the needle in this particular region. There are some studies showing that transforaminal epidural steroid injections in the lumbar spine are better at pain relief than simple interlaminar injections. However, there also studies showing there is no difference in the good to excellent results achieved with these different procedures.

The third type of epidural steroid injection is known as a caudal epidural. This procedure involves placing the needle through the bottom of the spine through an area known as the sacral hiatus. With a caudal injection, the Arizona pain management doctor is able to inject a much larger amount of steroid, as the medicine is able to reach multiple pinched nerves such as in a patient with spinal stenosis. Results with caudal epidural injections have been in line with the other two methods, with the caveat that caudal injections are able to reach numerous nerve roots and not just one.

Caudal Epidural Injection

Caudal Epidural Injection

Complications reported with epidural steroid injections are unusual but they do occur. Therefore they cannot be ignored and include such issues as a slight risk of infection, nerve injury, bleeding or allergic reaction to one of the medicines used. There have been reports of both transient or permanent nerve root injuries due to epidural injections, and There also may be transient weight gain, water retention or elevated blood sugars due to the steroid medication used.

Overall, epidural injections for sciatica have been of huge benefit to a lot of suffering patients. The injections often allow individuals to avoid surgery, get back to work, reduce the amount of narcotic medications necessary for pain relief, and stay active. If you or a loved one is suffering from sciatica, you are not alone. 1% of the population at any one point in time has the same issue. Help is available with Arizona Pain Specialists, the most comprehensive pain management clinics in Phoenix.Pain Management Doctors Phoenix

Currently, Arizona Pain now has a new Phoenix pain management clinic, its fourth location around the Valley. The Phoenix pain clinics accept over 50 insurances, including Workers Compensation, AHCCCS, Medicare, major medical and self pay. Personal Injury Liens are accepted as well.

For one number scheduling, call (602) 507-6550 Today!

When should I have surgery for a lumbar herniated disc?

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One percent of the population suffers from sciatica at any one point in time. Sciatica is pain down a person’s leg that is electrical and burning in nature and can be quite severe. It results from a disc herniation pushing on the nerve root, and the resulting inflammation Sciatica Treatmentcauses the pain traveling down the person’s leg through the area where that nerve root provides sensation.

Fortunately, most patients who experience severe sciatica do not need surgery to relieve the pain. When should surgery be undertaken? Here are the considerations for when an operation should be performed.

There’s only one true instance where surgery for a herniated disc is absolutely mandatory. If the disc herniation results in a condition called cauda equina syndrome, an individual will end up with bowel or bladder dysfunction along with significant pain and disability.

When cauda equina occurs, it is a true surgical emergency and should be addressed within 24 hours.

Cauda equina syndrome is rare, and a more common scenario is compression of the nerve root leading to motor weakness. This may show up as a foot drop, or quadriceps

Pain Management Phoenix AZ

Herniated disc pinching a nerve root.

weakness. It also may involve weakness of everting the foot, or other motor functions. It really depends on which nerve root is being pinched.

When motor weakness presents itself, it does not mean the patient has to undergo surgery. It should be watched very closely, and if it becomes progressive then surgery should be heavily considered. If it is not progressive, it can be watched for a month or two to see if function improves. So motor weakness is what is called a relative indication for surgery, not an absolute.

The additional indication for surgery is simply for intolerable pain. If an individual undergoes considerable conservative treatment for over six weeks, and the pain is not tolerable at that point, surgery can be considered. Epidural steroid injections for sciatica work well over 75% of the time. A series of injections may be necessary for best results. Along with the injections, pain management medication may be necessary along with PT, chiropractic, acupuncture and more. Over 95% of the time, satisfactory pain relief can be achieved so Pain Clinics in Phoenixthat surgery can be avoided.

A landmark study in the Journal of the American Medical Association showed that surgery for a pinched nerve allows patients to get back to work faster and to get rid of their pain quicker. Interestingly, at the one year point after surgery, the results were overall no different than if the individual had continued conservative treatment.

While a lumbar discectomy surgery is typically highly successful and maintains low risks, those risks cannot be ignored. There is a risk of infection, nerve injury, anesthesia complication, bleeding and failure to relieve the pain. Regardless of whether surgery is performed, the risk of a re-herniation at the same level is 10%.

If you or a loved one lives in the greater Phoenix and Scottsdale metropolitan area and is suffering from sciatica, let the best Arizona pain clinics in the valley APS Full Logohelp you. Arizona Pain Specialists has an award-winning team of double Board Certified pain management doctors along with exceptional Phoenix chiropractors.

The practice has multiple locations and offers pain management Mesa AZ, Glendale AZ, surprise, Tempe and Phoenix/Scottsdale trust. Call 602 507 6550 for one number scheduling today!

What are the 3 Different Kinds of Epidural Steroid Injections?

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Since the 1960’s, epidural steroid injections have been used in pain management successfully for pain relief. Since then, the theory of the injections has not changed. Applying the steroid medication around a pinched nerve bathes it with a hefty Sciatica Treatment Phoenixanti-inflammatory. Pain is usually relieved dramatically.

Steroids themselves have remained the primary medicine because nothing better has been developed that works as well. While the application of steroid doesn’t fix the disc herniation problem, it does relieve the pain while the body hopefully disintegrates the piece of disc that has squeezed out.

The initial type of epidural steroid injections that was invented were called interlaminar epidurals. This type involves the AZ pain doctor placing a needle between the bones in the back of the spine (called the lamina). The Arizona pain doctor uses a technique called the “loss of resistance” to feel as the soft tissues behind the spinal canal are breached and the canal is reached.

Epidural Injection PhoenixMost pain management doctors in Arizona now utilize ultrasound guidance or fluoroscopy, which is a real time form of x-ray for accuracy. Previous studies have shown a miss rate upwards of 40% without it. Do you want to go through the trouble of undergoing an epidural injection for burning sciatica and not have the highest accuracy available? That’s why the vast majority of pain doctors use some kind of image guidance.

A second type of epidural injection is a caudal epidural. This version is exceptionally helpful when multiple nerve roots are being pinched, such as with spinal stenosis. The injection point is at the bottom of the spine through an opening known as the sacral hiatus. A larger volume of steroid medication is injected, and it can reach multiple pinched nerve roots by gravity and provide pain relief.

The newest type of epidural injection is called a transforaminal epidural steroid injection

Caudal Epidural Injection

Caudal Epidural Injections are placed through the bottom of the sacrum.

(TESI). For this injection, the pain doctor in Phoenix or Scottsdale places the steroid in the area where the nerve root exits from the spinal canal, called the foramen. This way, the steroid goes much closer to the point of actual pinching. For the lumbar spine, this type of injection is immensely popular. Not as much, though, for the cervical spine. In this area, it presents a higher risk profile with numerous vessels being nearby.

The results of epidural injections have been consistently impressive overall. Numerous studies have shown the results of epidural steroid injections for sciatica match the results of surgical intervention at the one year outcome point (Eur Spine J. 2011 Apr;20(4):513-22.)

Most studies show between 75% and 90% effectiveness for steroid injections to help with sciatica symptoms. (Manchikanti et al, Pain Physician. 2010 Jul-Aug;13(4):343-55.) There are some studies that show transforaminal injections are superior to interlaminar (Roberts et al, PM R. 2009 AZ pain centerJul;1(7):657-68.)

When it comes to how many injections should be received, it may take a series of 3 injections to obtain optimal pain relief. This series can be repeated every few months. The objective is to achieve optimal pain relief while not overloading the body with too much steroid. The problem is it is not definitively known what is meant by overloading the body with steroids. So there are simply rough guidelines.

If you or a loved one is suffering from burning pain in the legs or arms, it may be due to a pinched nerve(s). The best Metropolitan Phoenix pain management clinics, Arizona Pain Specialists, have Board Certified pain doctors who are experts in epidural steroid Pain Management Doctors in Arizonainjections. Depending on the where the pinched nerve is present and how many are being compressed will determine the type of epidural injection that is indicated.

Arizona Pain accepts over 50 insurances, including Workers Compensation and Personal Injury, Medicare, Major medical, and some AHCCCS plans. Call (602) 507-6550 for one number scheduling!