People who are doing with sciatica of a chronic time. Often end up receiving epidural injections to relieve the pain. There are actually 3 different types of epidural injections that are well-known and performed by pain management specialist.
These 3 varieties of epidural injections work by alleviating swelling and inflammation that the nerve roots are experiencing in the epidural space.
The 1st variant of injections is called an interlaminar epidural injection and is applied in the epidural space. In the past these were done without x-ray guidance and simply by pain doctors or really any doctor and office setting just by using the feel.
Some doctors still perform them without x-ray guidance, however, it has been shown that without it 30% of the time the injection misses the epidural space. So most doctors in this day and age do use fluoroscopic guidance for placement.
The steroid injection with enter laminar epidurals is placed right over the dural sac which is not exactly overly scientific. The nerve root compression is actually happening as the nerve root exits from the epidural space. So within interlaminar injections steroid action has a bit of a ways to go to reach the problematic area.
This brings us to the 2nd type of epidural steroid injection, which is a trans-foraminal type of injection. This injection has become much more popular over last decade and allows injection doctors to place the steroid medication closer to the area of nerve root compression.
The steroid medication can decrease inflammation and swelling around the pinched nerve by bathing it in a hefty anti-inflammatory medication. Numbing medications are also typically placed which can help "break the pain cycle" and let the steroid then decrease inflammation as mentioned.
The 3rd type of epidural injections is termed a caudal steroid injection and involves the pain doctor putting a needle through the sacral hiatus and then injecting a large volume of both a numbing agent and cortisone.
This is not an exact science and what pain doctors hope is that a large amount of steroid will make it to the problematic areas for those nerves being compressed. Some research does show that caudal injections can work really well for acute sciatica.
A new research study out of the Massachusetts medical Society looked at treating chronic sciatica with caudal injections. The trial is actually done in the country of Norway and looked at steroid injections versus saline in patients who had over 3 months of sciatica.
Patients were followed for a period of one year. At the one year point half of the study participants reported feeling a lot better, and only 27% maintain persistent radiculopathy.
The interesting point here is that there was not a significant difference between the control group versus the steroid group. Therefore the conclusion is that caudal epidural steroid injections were ineffective for chronic lumbar radiculopathy.
Therefore based on this study the better course of action would be to utilize one of the other epidural steroid injection types of chronic sciatica. This would mean either using the interlaminar or transforaminal varieties.
These 3 varieties of epidural injections work by alleviating swelling and inflammation that the nerve roots are experiencing in the epidural space.
The 1st variant of injections is called an interlaminar epidural injection and is applied in the epidural space. In the past these were done without x-ray guidance and simply by pain doctors or really any doctor and office setting just by using the feel.
Some doctors still perform them without x-ray guidance, however, it has been shown that without it 30% of the time the injection misses the epidural space. So most doctors in this day and age do use fluoroscopic guidance for placement.
The steroid injection with enter laminar epidurals is placed right over the dural sac which is not exactly overly scientific. The nerve root compression is actually happening as the nerve root exits from the epidural space. So within interlaminar injections steroid action has a bit of a ways to go to reach the problematic area.
This brings us to the 2nd type of epidural steroid injection, which is a trans-foraminal type of injection. This injection has become much more popular over last decade and allows injection doctors to place the steroid medication closer to the area of nerve root compression.
The steroid medication can decrease inflammation and swelling around the pinched nerve by bathing it in a hefty anti-inflammatory medication. Numbing medications are also typically placed which can help "break the pain cycle" and let the steroid then decrease inflammation as mentioned.
The 3rd type of epidural injections is termed a caudal steroid injection and involves the pain doctor putting a needle through the sacral hiatus and then injecting a large volume of both a numbing agent and cortisone.
This is not an exact science and what pain doctors hope is that a large amount of steroid will make it to the problematic areas for those nerves being compressed. Some research does show that caudal injections can work really well for acute sciatica.
A new research study out of the Massachusetts medical Society looked at treating chronic sciatica with caudal injections. The trial is actually done in the country of Norway and looked at steroid injections versus saline in patients who had over 3 months of sciatica.
Patients were followed for a period of one year. At the one year point half of the study participants reported feeling a lot better, and only 27% maintain persistent radiculopathy.
The interesting point here is that there was not a significant difference between the control group versus the steroid group. Therefore the conclusion is that caudal epidural steroid injections were ineffective for chronic lumbar radiculopathy.
Therefore based on this study the better course of action would be to utilize one of the other epidural steroid injection types of chronic sciatica. This would mean either using the interlaminar or transforaminal varieties.
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