Lower Back Injections
Lower back injections include cortisone injections, epidural steroid injections, trigger point injections, and nerve blocks to eliminate pain at the site of injury or at the level of the spine where the pain signal is being transmitted. These injections may block the proliferation of inflammation around the tissue injury, or they may block the transmission of pain signals through their delivery to the epidural area of the spine. These injections will have the temporary effect of providing pain relief, but may be used as part of a program to strengthen the body so that patients do not experience back pain symptoms again. How may these treatments help patients to experience long-term back pain relief when they aren't involved in healing the tissues they are injected into? These treatments may provide patients with enough pain relief to get them out of bed and exercising again. Once patients are able to move their bodies again without being in severe pain, they may now have the comfort levels to begin and continue physical therapy program long enough to build strength and flexibility in the soft tissues of the spine. By the time the clinical effects of the injection treatments wear off, the patient's back may be protected against injury, spinal instability, and lower back pain. These treatments may give patients the ability to move comfortably long enough for the physical therapists to be able to do their jobs with patient compliance.
Epidural Steroid Injections (ESIs) are commonly used by many spine centers and pain management clinics as a way to restore patients to pain levels that enable them to resume a normal life. These treatments may enable patients to return to their jobs or continue their physical therapy program. An epidural steroid injection is delivered into the epidural space in the spine, near the vertebral wall. The substance in the injection can be a pain relieving lidocaine or corticosteroid. Steroids are used to decrease inflammation. The substance may also include a saline solution, which is used to merely flush out inflammatory substances.
Injections may be used primarily as a treatment, or they may also serve as diagnostic purposes. Today, we have amazing diagnostic resources in the form of experienced medical doctor diagnosticians and medical imaging tests. These imaging tests are extremely detailed to give doctors the ability to see what's normal in the spine, and where the pathology is. And the doctors reading these images are very sensitive to seeing lesions in the spine and problems causing its structural instability. The problem is, there are a high percentage of cases where doctors find lesions near the source of the patient's pain, but these lesions are not actually the cause of pain. In these cases, injections may be used as a diagnostic tool to confirm that lesions are the cause of pain. If the injection results in pain relief for the patient, into the lesion in question that will provide the doctors with the conformation they are looking for.
Risks and Complications: The risks of injections include infection, bleeding, nerve damage, or puncture of the Dura. The Dura is a baloon-like structure that contains the nerves and the spinal fluid. In the relatively rare event of a dural puncture, the temporary condition known as spinal headache may produce symptoms including neck stiffness, nausea, photophobia (light sensitivity), tinnitus (ringing in the ears), and dizziness.
How long does a spinal headache last? The symptoms of this condition typically go away without treatment.
Who performs lower back injections? Injections may be performed by spine surgeons, physical medicine and rehabilitation physicians, and anesthesiologists trained in pain medicine.
Lumbar Epidural Steroid Injections are often used to treat lower back pain symptoms that are accompanied by radicular pain. Radicular pain is pain that radiated at and away from the source of the injury. Sciatic is the most common type of radicular pain caused by compression of the lumbar nerve root that gives rise to the sciatic nerve. Sciatic nerve pain may travel the length of the affected leg, to the foot. Facet joint arthritis and lumbar disc herniation are two spine conditions that occur in the lumbar spine to affect the sciatic nerve. In response to the compression or irritation of the sciatic nerve, inflammatory chemicals that are produced may include substance P, PLA2, arachidonic acid, TNF-?, IL-1, and prostaglandin E2) and immunologic mediators. Steroids delivered near the cells that release these inflammatory chemicals may inhibit the inflammatory response.