Epidural and Transforaminal Injections for Sciatica

The purpose of performing an epidural is to introduce depot steroid into the epidural space.

Symptoms

There are symptoms, signs, and tests that suggest spinal stenosis and nerve root compression with an epidural. Nerve root compression, classically sciatica, is indicated by neuropathic symptoms including burning, shooting, tingling, and numbness. Signs are represented by abnormal weakness, reflexes, and positive straight leg raising with sciatica. In addition, allodynia may be present.

Diagnosis

The diagnosis is made from the history examination and tests. Both SPECT, CT, and MRI scans can be used to find the inflamed disc and predict the response to the injection.

Nerve root compression, classically sciatica, is indicated by neuropathic symptoms including burning, shooting, tingling, and numbness. Signs are represented by abnormal weakness, reflexes, and positive straight leg raising with sciatica. In addition, allodynia, (pain without a painful stimulus), may be present.

Contraindications include patient refusal, raised intracranial pressure, bleeding disorders (Warfarin), systemic infection, and septic spots at injection site. In addition, injections in patients with a fixed cardiac output, can occur only if using local anesthetics in injectate. Active neurological disease can be a contra-indication as well.

Treatment

These injections are performed under X-ray control, as can be seen below:

epidural

Only clear dexamethasone steroid is used. X-ray control means that if the procedure fails, then the failure is not because the steroid was put in the wrong place.

The steroid is being introduced to deal with the component of spinal stenosis caused by inflammation and it has no effect on mechanical nerve root compression. Anecdotally, if a patient responds to anti-inflammatory drugs, they will respond well to epidural steroids. The same holds true for mechanical back pain and facet joint injections.

Epidural approaches include caudal, lumbar, lumbosacral roots, and dorsal root ganglion. Caudal epidurals are useful for treating inflammatory spinal stenosis to the level of L3/4, if a volume of approximately 20ml of injectate is used. The following representation is an epidural injection.

Suffering? Get In Touch

There is no need to suffer with debilitating sciatica or nerve root pain; help is at hand! If you are suffering with pain and it will not go away despite the passage of time and using simple pain relieving medications, physiotherapy etc., then I can see you for a comprehensive evaluation of your problem.

Sometimes I alone cannot help you and I work closely with colleagues – surgeons, physiotherapists and psychologists which is important in such care – the multidisciplinary team.

Email enquiries@painmanagement.org.uk or call us on 020 7060 5109 for an appointment. Leave a message if you get through to a voicemail and you will be called back.

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