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Injections
of steroids into the lumbar epidural space are frequently
used for low back and related radicular leg pains. The
question is do they work?
The
answer: It depends on whom you ask. The controlled studies
are split. Two major problems complicate the story. The
first is that many different diagnoses may cause the pain,
and epidural injections may work for some of these diagnoses
better than others. The second problem is that the success
of the injection may depend on the technique that is used.
The
traditional epidural injection technique involves the
doctor feeling the patient’s spine in order to guide the
placement of a needle between the spinal vertebrae. A
newer technique involves using x-ray fluoroscopy to guide
the needle directly to the neural foramen, the point where
the affected spinal nerve root exits the spine. This is
likely to increase the success of the procedure, but a
controlled study using such injection techniques has not
yet been done.
However, a study in the Archives of Physical Medicine
& Rehabilitation did give added support to this idea.
75% of the 69 patients treated with these more precisely
placed injections demonstrated good long-term benefit.
At The Richeimer Pain Institute, we also have had good
results with this refined epidural technique. For patients
with nerve root pain involving one or two roots, I believe
that fluoroscopically guided foraminal injections will
prove to be superior to the approaches that do not use
x-ray guidance. Epidurals in general, but especially foraminal
injections, do not appear to be as effective if the pain
is caused by widespread degenerative or arthritic problems
in the spine.
Do
epidural steroid injections work?Yes,
if the problem is back and leg pain triggered lumbar disc
herniations, and if fluoroscopy is used to guide the injection
directly to the affected nerve roots.
Do
epidural injections work for other causes of back pain?
Good data is not available. In my experience, the injections
can often help, but with other diagnoses the rate of success
is not as great.
Copyright
© 2000, Steven Richeimer, MD.
You may reach The Richeimer Pain Institute at www.helpforpain.com
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