Spinal Injection Therapy
Epidural injections are most effective
in the presence of nerve root compression. (Epidural
- Space outside the dura or covering of the spinal cord.
This space runs the length of the spine). The most commonly
performed injection is an epidural steroid injection.
In this approach, a steroid is injected directly around
the dura, the sac around the nerve roots that contains
cerebrospinal fluid (the fluid that the nerve roots
are bathed in).
Scientific studies often demonstrate inflammation of
the spinal nerves following prolonged compression, which
leads to irritation and swelling. This irritation occurs
at the level of the root of the lumbar nerves. The injection
of steroids, which are potent anti-inflammatories, is
made into the epidural space, close to the affected
nerve roots. These injections must be given by experienced
specialists who are well trained in this technique.
Improvement of the symptoms appears to correlate well
with the resolution of the nerve root inflammation.
These injections are most effective when given in the
first weeks of the onset of pain. Usually, two to three
injections one to two weeks apart are required. Only
a single injection is given if complete pain relief
Doctors limit the number of epidural steroid injections
to a maximum of three to avoid systemic side effects
of the steroids. Side effects are minimal and consist
mainly of mild tenderness in the area of injection which
disappears in 1-2 days. Success is dependant on the
cause of the pain and how long the pain has existed.
The sooner the treatment is instituted, the better are
the chances of getting well. This treatment, along with
analgesics and physical therapy has brought relief to
thousands of patients, avoiding, in the majority of
cases, the need for surgery. Prior to the injection,
the skin is anaesthetized by using a small needle to
numb the area in the low back (a local anaesthetic).
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