Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain especially when accompanied by radicular leg pain, a condition commonly known as sciatica. They have been used routinely for low back problems since 1952, although the earliest recorded instance of an injection into the epidural space was in 1901. It is precisely because this procedure is so routine and has been done for so many years that patients, as well as many of those within the medical community itself, suppose that the efficacy of the procedure must have long since been established. The truth, however, is that although there are many studies documenting the short-term benefits of epidural steroid injections, the efficacy of long-term effectiveness continues to be debated and is not well studied in the literature. In fact, the greatest risk posed by ESI’s may very well be the delay in receiving appropriate treatment allowing the continued progression of degenerative changes of the spine which go unnoticed because of the short-term, temporary relief of pain.
In addition, the ideal number of epidural injections to be administered for a given clinical scenario is often unclear because there is no clear data in the current literature on the exact number of ESIs to be administered and the timing that should be employed. Current clinical practice patterns suggest a “series” of 3 epidural injections per episode be recommended, regardless of clinical response, although there are no medical outcome studies to clearly support such a regimen. If the first and second were ineffectual, then what would make one think that the third would be? Further, if you had trouble getting your car started on three separate occasions wouldn’t you begin to suspect that something was wrong?
An Epidural steroid injection reduces pain because it contains corticosteroids that mimic the effects of the naturally occurring hormones cortisone and hydrocortisone which serves to reduce inflammation around irritated nerves. The effect of the steroid is temporary and the cause of the nerve irritation, commonly the degenerative changes of the disc resulting in a bulge or herniation yet remains. Worse, there’s a chance these hormones in such artificially high concentrations might actually weaken the spinal bones, ligaments, and the tendons of nearby muscles compounding the problem. ESI’s are usually limited to just a few a year because steroid injections also suppress the body’s natural hormone balance and can lead to adrenal insufficiency, a serious medical condition. Delaying repeat injections is presumed to allow your body a chance to return to its normal balance although there is little evidence to support this notion. The risk of these side effects may increase with the number of steroid injections received and the dose given in each injection.
Other Risks Include:
Death of nearby bone (osteonecrosis) Joint infection Nerve damage Skin and soft tissue thinning around injection site Temporary flare of pain and inflammation in the joint Tendon weakening or rupture Thinning of nearby bone (osteoporosis) Whitening or lightening of the skin around injection site
What is the Alternative?
Modern medical science has finally developed an effective alternative to endless injections or simply living with the pain – Spinal Decompression Therapy. Performed on a special, computer controlled table similar in some ways to an ordinary traction table a single disc level is isolated and by utilizing specific traction and relaxation cycles throughout the treatment, along with proper positioning, negative pressure can actually be created within the disc. It works by gently separating the offending disc 5 to 7 millimeters creating negative pressure (or a vacuum) inside the disc promoting the retraction of the bulging disc tissue. This negative pressure also pulls water, oxygen, and nutrients into the disc, thereby re-hydrating a degenerated disc and bringing in the nutrients needed to begin the healing process. As the disc retracts the pressure comes off the nerve eliminating the irritation that triggered the inflammatory process.
Spinal Decompression is an effective, safe, and cost-effective procedure without the risk of drugs, injections, surgery, or anesthesia. Spinal Decompression not only significantly reduces pain in many patients, but also enables the majority of patients to return to more active life styles.