By Scott A. Kelly, MD
Suffering from low back pain? You’re not alone! It might begin as an ache after a round of golf or working in the yard. On the other hand, it can begin as a sudden, intense pain that can affect your function and alter your quality of life. Epidemiological statistics indicate that there is an 80% chance that you will experience significant low back pain at some point in your life. In the majority of cases, pain relief is accomplished by simple conservative measures such as physical therapy, activity modification, and oral medications. When conservative therapy fails, there is still hope of avoiding surgery. Epidural steroid injections (ESI) can provide both diagnostic and therapeutic benefits and serve as an integral part of a comprehensive spinal-rehabilitation program.
An ESI is the administration of a long-lasting steroid solution into the epidural space (the area which surrounds the spinal cord and the spinal nerves). ESIs work by delivering steroid, the most potent anti-inflammatory in modern medicine, to the exact area of inflammation. Fluoroscopic or live X-ray guidance is used by interventionally-trained physicians to deliver the steroid to the precise location in the spine. By injecting directly into the spine, we can avoid many of the systemic adverse effects common to oral steroid medications. In addition to the obvious therapeutic benefits of ESIs, due to the precise nature of fluoroscopic guided injection, it frequently enables the physician to determine the exact pain-generator in the spine.
The History of Epidural Steroid Injections
ESIs are not a new concept. The first documented ESI to treat low back pain was reported in 1901. The first ESI for the treatment of a lumbar disc herniation occurred in 1952. As medicine and technology advanced in the 1980s and 1990s, the addition of fluoroscopy became more commonplace. Now, this procedure is significantly more effective and most importantly, safer.
How Many Injections Will Be Needed?
The interval between and the number of injections given to a patient varies from individual to individual depending upon the clinical response. However, it is not uncommon for the treating spine physician to administer up to three epidural injections per year. Clinical judgment and communication between the physician and the patient are what determines the appropriate number of injections and scheduling variations.
Epidural steroid injections play an integral role in the nonsurgical management of low back pain that is unresponsive to conservative management including rest, activity modification, physical therapy, and oral medications. They can serve both a therapeutic and diagnostic role in the nonsurgical management of low back pain. Benefi ts of the treatment include decreasing back and sciatica (radicular) pain, improving quality of life, decreasing use of oral analgesics, improving return to work statistics and helping to avoid surgery in some patients.