Epidural Steroid Injection for Back Pain Treatment

Sorayouth Chumnanvej, M.D.

Back pain is a common problem that neurosurgeons confront in everyday working because of trauma, civilised lifestyle or inappropriate working ergonomics . Back pain including degeneration of intervertebral disc or failed back syndrome are found gradually more. Back pain could be variety from sudden aching back, constant pain, sharp pain or dull aching back. Back pain could last from a few days to a few weeks; this is called acute back pain. Chronic back pain could last for more than six months. Practicing, medical treatment is the first appropriated option. Taking over-the-counter pain killers, resting and rehabilitation could facilitate and relieve the back pain. However, if it worse or be impossible to wait, equivocal of imaging identification or ever several times surgical correction, seeking for optional treatment is recommended.

Neurosurgeons will define the exact cause of back pain by the history taking and neurological physical examination. Plain X-ray film, CT lumbrosacral spine and MRI lumbrosacral spine will be helped to confirm the diagnosis. Surgery will be indicated regarding to the definitely identified cause which is concordant to the spinal imaging. On the other hand, if the imaging is equivocal or nonconcordant to the patient clinical problem, according to this condition, an alternative option for back pain relieving is the Epidural Steroid Injection . As the result, the diagnosis and pain relieved treatment could be achieved.

Epidural Steroid Injection is the available option for relieving particularly back pain, leg pain or back with leg pain. To inject the combination of triamcinolone and anesthetic agent above the thecal sac or nerve root is the procedural technique. Selective nerve root block is defined when the injection is performed specifically on desired or affected lumbar nerve root. Because of the inflammation, the nerve root is irritated. As a result, back pain is occurred. To select the nerve root prior injection with affected lumbar nerve root, selective nerve root block is indicated. Recently, with the novel tool, epidural steroid injection or selective nerve root block are possible to achieve in only one injection. This instrument is called Pain Control Manipulator . As figured, this novel instrument is designed and assembly in Korea. The only one entry point is created as needle puncture at the lower back. Even diagnostic and relieving back pain could be done both.

Indication

  •  To diagnose radicular pain, particularly when imaging is puzzling.
  • Evidently radicular pain (shooting pain in the limb)
  • To relief pain of upper and lower back pain secondary to spinal stenosis, disc herniation with or without radicular pain, and refractory back pain of unknown etiology.
  • To relief pain in patients who are not surgical candidates.

Contraindication

Absolute contraindications include

  • Bleeding diathesis. Patients who are on anticoagulants should discontinue usage and clotting parameters should be checked prior to the procedure. Aspirin is not an absolute contraindication; however, newer antiplatelet medications such as Plavix should be discontinued.
  •  Major hypersensitivity (anesthetic solutions and steroids)
  • local infection at the site of the proposed injection
  • systemic infection
  • Contraindication to steroid therapy (active bleeding from gastritis or peptic ulcer disease, resistant diabetes mellitus, severe congestive heart failure, and severe hypertension).
  • Contrast allergies