Epidural steroid injections for spinal pain

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-07-10

Introduction

Spinal pain is the most common of all chronic pain disorders. The number of individuals that have, at some point in their life, experienced spinal pain has been reported as 54 to 80%. After the initial painful episode, the prevalence of persistent low back and neck pain ranges from 26 to 75%.

Axial (neck or low back pain) and radicular pain (radiating pain to arm or leg) may arise from any anatomic structure capable of transmitting pain (the pain generator).  Pain generators include vertebral discs, nerve roots, dura (the outer layer of membrane surrounding the brain and spinal cord), muscles, fascia (soft, connective tissue), ligaments, and facet joints. Injury to any of these structures results in the release of inflammatory mediators. Epidural injection of steroid (cortisone, corticosteroid) is one of the most commonly used interventions to decrease the inflammation in managing persistent spinal pain.

Historically, the epidural steroid injection is the first-line invasive therapeutic procedure of choice in patients with spinal pain. In 1901, the first independent reports on the use of caudal epidural injections in the treatment of lumbar nerve root compression were published. The first reportedly successful use of lumbar epidural injections as a treatment for sciatica was in 1909. In 1930, a success rate of 61% was reported for the treatment of sciatica following the caudal injection of large volumes of local anesthetic and saline. The first reported use of epidural steroids was in 1957 as a treatment for radicular leg pain.

Spinal Stenosis

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-07-19

What is Spinal Stenosis? 

Spinal stenosis is defined as narrowing of the spinal canal (the canal in the center of the spine), lateral recess (the narrowing of the tunnels where the nerve roots exit the central spinal canal), or intervertebral foramina (holes in the vertebrae which nerve roots exit). It can occur at any age and is typically due to the degeneration and enlargement of the facet joints (small joints between upper and lower vertebrae), the protrusion or herniation of the intervertebral discs and/or ligamentum flavum hypertrophy (a strong ligament that connects the vertebrae together). The narrowing of the canals puts pressure on the neural elements of the spine, including the spinal cord and nerve roots. Pressure on the upper part of the spine (neck area) usually produces pain, numbness, tingling or weakness in the shoulders, or arms. Pressure on the lower part of the spine (low back area) usually causes similar symptoms in the legs.

Sciatica

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-06-10

Introduction

Sciatica is a buttock pain radiating down the back of the thigh and leg and possibly into the calf or foot.  Other characteristics of sciatica include varying degrees of weakness in the leg muscles and numbness and/or tingling that radiates down the leg.  These symptoms occur because of compression and/or irritation of the sciatic nerve or nerve roots which are forming the sciatic nerve. The areas in the buttock and leg affected by this compression are the areas that the sciatic nerve supplies with messages for normal function.  There are many other names for sciatica including lumbosacral radicular syndrome, radiating low back pain, nerve root pain, and nerve root entrapment.