In general terms, spinal stenosis involves the narrowing of the spinal canal. Because the spinal canal houses the spinal cord and nerve roots, these components can easily become compressed. Most of the time, this problem occurs in the neck and the lower back.
Additionally, spinal stenosis is caused by age-related spinal degeneration and wear-and-tear changes related to osteoarthritis. With age, bone spurs, swollen ligaments, and herniated disc material may begin to crowd the spinal canal. In less common cases, some people are born with narrow spinal canals. These people are more prone to developing the condition at a younger age.
There are three basic types of spinal stenosis and they are mainly categorized by the region of the spine that is affected.
Spinal Stenosis Locations
There are two main ways in which doctors categorize spinal stenosis types. The first way breaks down these types by their location:
- Lumbar Spinal Stenosis: Lower back region
- Thoracic Spinal Stenosis: Middle back region
- Cervical Spinal Stenosis: Upper back region
Additionally, doctors may categorize SS types by the part of the spinal column that the condition narrows:
- Foraminal Stenosis: Narrowing occurs in the small openings that allow nerve roots to exit the spinal column
- Lateral Recess Stenosis: Narrowing occurs in the back of the spinal canal where the nerve roots initially branch off
- Central Canal Stenosis: Narrowing occurs in the main spinal canal, which protects the spinal cord
The common thread between these conditions are debilitating symptoms and chronic pain. Sometimes, SS does not cause pain, but it will in cases that result in nerve compression. In these cases, patients should always seek professional treatment.
This type of spinal stenosis is the most commonly occurring type. Sometimes, doctors or medical experts may refer to foraminal stenosis as lateral spinal stenosis. In the back of the spine, there are side holes that nerve roots exit through. Experts refer to these anatomical structures as neuro-foramen. In the neuro-foramen, bone spurs that have developed from a degenerating disc or arthritic facet joint can press on these nerve roots. As a result, the narrowing space traps the emerging nerve roots. Speaking visually, this type of spinal stenosis literally pinches the nerves.
Central Canal Stenosis
A membranous sheath of dura mater known as the thecal sac surrounds the spinal cord. Narrowing of the central canal in the lumbar area leads to compression of this spinal component. This narrowing can cause pressure on the nerve bundle located at the end of the spinal cord (known as the cauda equina). Additionally, this narrowing may also lead to the compression of the individual nerves located within the thecal sac.
Far Lateral Stenosis
In some cases, narrowing occurs beyond the neuro-foramen. Usually, this development stems from bone spurs (which form bulging discs), the facet joints, herniated discs, and ligamentum hypertrophy. When this narrowing occurs to the side of the neuro-foramen, experts call it far lateral stenosis. With spinal stenosis, there is generally a combination of far lateral and foraminal stenosis.
Spinal Stenosis Causes
Spinal stenosis usually results from the gradual deterioration of the spinal anatomy. That being said, the condition may also be associated with a back or neck injury. Under normal circumstances, the spinal cord travels from the brain through the spinal canal. Individual nerve roots branch off of the spinal cord and extend into the body. The canals protect nerves from damage, but there are multiple ways that lead to constriction over time:
- Formation of bone spurs
- Inflammation of nearby surrounding soft tissue
- Herniated or bulging discs that put pressure on the spinal canal
- Calcification of the spinal ligaments
- Spinal misalignment caused by vertebrae slipping out of place
- Other issues, such as tumors, diseases, or infections
Spinal structures will naturally degrade over time. While this is the case, chronic pain and other debilitating symptoms will only appear in cases where the nerves are pressured.
Spinal Stenosis Symptoms
Symptoms of spinal stenosis will vary by the location and other individual factors, however, there are many blanket symptoms that all types share. Some of the most commonly experienced symptoms of spinal stenosis include:
- Burning sensations
- Loss of fine motor skills
- Limited mobility
- Muscle weakness
- Local and traveling pain
- Numbness and tingling
It is important to note that a person may have evidence of spinal stenosis on an MRI or CT scan but are unaffected in any meaningful way. In such cases, symptoms sometimes gradually appear and worsen with time. Therefore, it is important to recognize the signs of spinal stenosis and seek professional medical care when necessary.
If you experience neck or back pain that lasts for more than a few days, then you should consider visiting your primary care physician. Additionally, it is not uncommon to experience anxiety involving this process, but this can be alleviated by taking it slow and asking questions. Generally speaking, reaching a diagnosis for most conditions involves three important steps:
- Symptom Discussion & Medical History: In most cases, a diagnosis starts with a question-and-answer session between you and your doctor. Your doctor will ask you to describe the symptoms you are experiencing, as well as a variety of other factors. This may include facts about your lifestyle, your diet, previous treatments, and other pre-existing medical conditions. Additionally, your doctor may ask you questions about your family’s medical history. This is because many conditions that cause back and neck pain are inheritable.
- Physical Examination: To better understand the source of your symptoms, your doctor will apply pressure around your neck and back. Furthermore, they will also test your range of motion and attempt to identify areas of pain to further understand the source of your symptoms. Unfortunately, this process is usually uncomfortable, but it provides your physician with valuable information.
- Medical Imaging: In order for your doctor to make an accurate diagnosis of spinal stenosis, he or she will often resort to medical imaging. Usually, this comes in the form of an MRI or CT scan, which provides an inside view of the spinal column. These imaging tests will show the exact cause of the narrowing, such as herniated disc material or bone spurs.
Once you have received your diagnosis, your doctor will work with you in order to develop an personalized care plan. Generally, many spinal stenosis patients are actually able to return to normal activities without having to resort to surgery. The reason for this is because a range of more conservative treatment usually brings more meaningful relief from symptoms.
Commonly used conservative methods are:
- OTC and prescription pain medication
- Physical therapy
- Massage therapy
- Low-impact exercise
- Hot and cold compresses
- Corticosteroid injections
- Chiropractic adjustments
- Intermittent rest
Minimally Invasive Surgery
Minimally invasive spine surgery is a safer and effective alternative to traditional open back procedures. There are two main types of minimally invasive spinal procedures: decompression and stabilization. Both types can be used to treat SS, however the best option for you will depend on your individual case.
This type of minimally invasive surgery is primarily used to treat mild and medium cases of spinal stenosis. Most stenosis patients fall within this category. The two most commonly used minimally invasive decompression surgeries for spinal stenosis are the laminotomy and foraminotomy. With decompression surgery, the common goal is to remove the diseased portion of the spine. This may be a bone spur, a herniated disc, or some other abnormality that compresses nerve roots.
A surgeon can typically perform the procedure through a small, 1-inch incision. The smaller incision allows for faster recovery time, less scarring, and less damage to surrounding muscles. Once the incision is made, the surgeon removes the infected portion of the spine and the nerve decompresses. Because this procedure is performed as an outpatient procedure, patients usually return home the same day the surgery is done.
Stabilization surgery is used for more severe cases of spinal stenosis, and may be required to treat chronic symptoms and pain. This procedure is performed through a small incision in the back, side, or neck. The access point depends on the location of the patient’s spinal stenosis. In order to access the affected area, the surgeon will carefully move aside the surrounding muscles to avoid unnecessary damage. Once the spine is accessible, the surgeon then removes the affected area, which is usually a vertebrae or disc. Once your doctor has removed the area, an implant takes its place in order to stabilize the spine. Common examples of minimally invasive stabilization surgery includes transforaminal lumbar interbody fusion and anterior cervical discectomy fusion.
If you have pain in your neck or back lasting for more than a few days, please contact us at (855) 853-6542 or fill out a form online. At the OLSS, we understand that the medical needs of each patient are different. We will work tirelessly to ensure that you receive the personalized care plan you need for your case.
Lower back pain affects nearly one-quarter of the population. If you suffer from chronic back pain, then you know how it can impact your life. Pain prevents you from doing the things you love. It keeps you from working and enjoying time with your family and friends.
You’ve tried to deal with the pain on your own. Over-the-counter medications aren’t helping. You don’t want to continually use dangerous and addictive prescriptions. You just want to wake up in the morning without that awful reminder that something is not right with your back.
When managing your chronic pain requires more aggressive treatment, you may need to seek the help of a pain management specialist. These professionals are specifically trained to treat complex, chronic pain.
Use this guide to learn more about pain management specialists, who they help, and the treatments they use to battle chronic pain.
What is a Pain Management Specialist?
Individuals with chronic pain often require a comprehensive approach to treat the condition. Advances in medicine have given doctors and other professionals better insights into the physiology of pain. Moreover, continuous research provides medical professionals with more and more tools to treat pain.
A pain management specialist has special training and experience to treat complex, chronic pain issues. Doctors specializing in pain management undergo extra training to get board-certified in this area. After they complete their medical degree, they enter into a fellowship program. This in-depth program allows for a higher level of study and practice, making them experts in the field.
Fellowship programs usually require at least one year of intensive training. Those entering a pain management fellowship often study anesthesiology, neurology, physiatry, and physical medicine. After the fellowship is completed, they become eligible for board certification in their particular area of pain management.
How is a Pain Management Specialist Different from a Typical Doctor?
Board-certified pain management specialists have a deeper understanding of the complexities of pain. They are better qualified to diagnosis painful conditions accurately. Their vast knowledge of different medications allows for safer and more accurate prescriptions that reduce pain. In addition, they develop skills to perform pain management procedures like the ones mentioned later in this article.
What Back Pain Conditions Can These Specialists Help?
Unlike strains or sprains in the back, chronic back pain is more challenging to treat. When conservative treatments like over-the-counter medications, physical therapy, and changing personal habits aren’t successful, a pain management specialist can help.
Common conditions that can require more aggressive pain management include:
- Failed back surgery syndrome: If there is no relief after one or several back surgeries, the source of the pain may be difficult to pinpoint. It can be due to scar tissue, arthritis, or nerve damage.
- Fibromyalgia: This disorder causes various levels of pain throughout the body. Pain can be widespread or migrate to different regions of the body. Fibromyalgia can be devastating to a person’s physical, mental, and social well-being. There is no known cure for this condition. So, the best course of treatment involves managing your symptoms.
- Neuropathy: Most pain signals start from the source of a trauma and travel through the nerves to the brain. Neuropathy is a distinct type of pain that originates in the nerves. The nerves send faulty pain signals to the brain. This condition can be caused by an injury, diabetes, infection, or substance abuse.
Treatments for Chronic Back Pain
A pain management specialist uses a variety of treatments to help your chronic back pain. Treatments can reduce or even eliminate symptoms. In addition, these treatments may reduce reliance on strong, often addicting, medications. Common pain management techniques for the lower back include:
Intraspinal drug delivery supplies pain and anti-inflammatory medications right to the source of the problem. Injections of corticosteroid medications cause a nerve block, which prevents pain signals from reaching the brain.
A pain specialist numbs the area where the injection takes place. Then the specialist uses live x-ray guidance to inject medications into the epidural space of the spine. This space is the outermost part of the spinal canal, which houses spinal nerve roots and other tissues. The corticosteroid helps to shrink swelling, which can cause pain and pressure around the nerve roots.
This minimally invasive procedure freezes the outer layer of nerves to disrupt pain signals that would otherwise travel to the brain. During the procedure, a specialist inserts a tiny probe—about the size of an IV needle—into the affected area. At the top of the probe is a tiny ball of ice. It is cooled to around 3 degrees Farenheit by pressurized gas. This intense cold causes a freezer burn on the surface of the nerve. A recent study found patients receiving this treatment experienced a significant reduction in pain for up to six months.
Repeated cryoneurolysis treatments may be necessary as the nerve begins to regenerate.
Similar to cryoneurolysis, this procedure uses a probe to disrupt the nerve’s pain signals. Instead of using cold, however, radio frequency waves heat the tip of the probe. Using live x-rays, the specialist numbs the affected nerves. Then, your doctor will create a lesion on the nerve with the heated probe.
This minimally invasive procedure usually takes around an hour. Patients often return home the same day. However, pain relief may take up to 10 days to reach full impact.
Spinal Cord Stimulation
By inserting a spinal cord stimulator (SCS) into the back, it helps to mask pain signals before they can reach the brain. Similar to a pacemaker used in the heart, an SCS delivers electrical pulses to the spinal cord. The pulses modify the way in which your nerves dispatch pain signals to the brain.
Pain specialists use a two-stage process for spinal cord stimulation. The initial, trial SCS determines if this procedure will benefit you in the long run. The trial phase usually lasts from 4 to 7 days. Then you will return to the doctor’s office to discuss any relief of symptoms. If the trial stage shows a significant decrease in pain, a permanent SCS will be implanted.
This procedure involves placing electrode leads into the affected site. Specialists use small incisions to reach these areas. A small part at the back of your vertebrae is removed to make room for the leads. The leads are then secured with sutures in the epidural space.
Once the leads are secured, wires are tunneled through the back and attached to the pulse generator. Your doctor will insert the device into the skin just below the waistline. Once your doctor has connected everything, he or she will close the incision.
The goal of spinal cord stimulation is a 50 to 70% reduction in pain. The procedure doesn’t work for everyone. This is why the trial stage is necessary. Some studies show long-term pain relief in up to 80% of patients.
Finding Treatment for Your Chronic Back Pain
All the treatment options for chronic pain can be overwhelming. You just know you’re dealing with pain and you want it to go away.
Consulting with our experts at Orthopedic & Laser Spine Surgery may be the game changer for managing your chronic pain. Our award-winning surgeons and medical staff specialize in pinpointing the source of your pain. Using the latest research, technology, and treatments, we help people, just like you, who struggle with pain every day.
The first step to successfully managing your pain is setting up an appointment. Don’t hesitate to find out how our wide range of treatments can help you get your life back.
Rotator Cuff Tendinitis is a leading cause of shoulder pain among athletes and middle-aged individuals. But, anyone can develop this disorder.
Our shoulders are the most flexible joints in our body. And, it’s easy to take these joints for granted until we start to feel pain. This guide will help you understand how the shoulder works and how rotator cuff tendinitis can develop.
Understanding Your Shoulder
Three main bones make up your shoulder. Your upper arm bone, known as the humerus, connects with the scapula (or shoulder blade) and the clavicle (or collarbone). These bones are connected by a series of muscles and tendons at the shoulder joint. This ball-and-socket joint is also known as the rotator cuff.
At the rotator cuff, four main tendons merge over the top of the humerus. They connect with muscles as well as the shoulder bones. This structure keeps the shoulder stabilized and prevents the humerus from popping out of the joint. In addition, lubricating sacs, called the bursae, help the rotator cuff tendons to glide during movement.
The rotator cuff controls the flexibility and movement of the shoulder. As the name suggests, it allows the shoulder and arm to rotate up and down, from front to back, and in or out.
Although your shoulder joint is reinforced by tendons, muscles, and ligaments, certain movements and activities can cause injury.
What is Rotator Cuff Tendinitis?
Sometimes referred to as shoulder impingement or impingement syndrome, this condition involves the tendons of the shoulder joint. When these tendons are damaged or irritated, it causes inflammation, which then results in pain and swelling.
Rotator cuff tendinitis usually develops gradually as a result of repeated irritation to the area. It occurs in athletes who engage in repetitive overhead movements like throwing, swimming, or playing tennis. In addition, as we get older, our muscles and tendons are more prone to injury. Those with occupations that require repetitive lifting or other overhead activities (like painting) are also at risk. In addition, a trauma to the area, like falling, can injure the shoulder tendons.
Symptoms of Rotator Cuff Tendinitis
Symptoms of this condition usually start with dull pain or swelling in the front and top of the shoulder. You may also experience pain in the outer part of the upper arm. This pain may worsen when you lift your arm or attempt to reach behind you.
Other symptoms include:
- Decreased range of motion in the arm and shoulder
- Sudden pain while reaching, lifting, or performing overhead activities
- Pain while pushing, pulling, or lying on your side
- Difficulty sleeping because of shoulder pain
- Muscle weakness
- A clicking sound in the shoulder when raising your arm
- Trouble with daily activities such as putting on a shirt or brushing your hair
Treating Rotator Cuff Tendinitis
A proper diagnosis of tendinitis is needed to rule out other causes like a bone fracture or arthritis. Your doctor can diagnose your shoulder pain by discussing symptoms and completing a physical exam.
In some cases, the doctor may order imaging tests such as x-rays or MRIs to view the damage to your shoulder joint and soft tissues.
Most of the time, this condition only requires conservative treatments. Resting and icing the area may help with the pain and swelling. It is important not to return to stressful overhead activities until your tendons and muscles have had a chance to heal.
Pain management can also include using anti-inflammatory medications (or NSAIDs). Over-the-counter medications like aspirin or ibuprofen can help to reduce pain and swelling.
A physical therapist can perform strengthening exercises to stabilize the area and improve your range of motion. In addition, a physical therapist will suggest ways you can change your habits and prevent further irritation of the shoulder joint.
In more severe cases, a steroid injection may be used to reduce inflammation.
If these conservative approaches fail to provide relief after several months, surgery may be the next option. Surgery is usually recommended when there is a tear in one of the rotator cuff tendons.
In many cases, surgery involves a shoulder arthroscopy. During this procedure, the orthopedic surgeon makes a small incision in the shoulder and inserts a tiny camera. The camera allows the surgeon to assess the affected area and shave off small parts of bone, giving the cuff tendon more space. This prevents further irritation and pinching of the tendon. This procedure also allows the surgeon to remove damaged tissue and repair minor tendon tears.
When a tendon has a major tear, open surgery may be necessary. The surgeon will create more space for the damaged tendon by trimming the tendon and cutting out a small piece of the humerus. Then the surgeon reattaches the tendon to the humerus with stitches or tacks.
Preventing Rotator Cuff Tendinitis
There are a few things you can do to decrease shoulder strain and thus reduce your risk of developing rotator cuff tendinitis. These things include:
- Use lighter weights during strength training.
- Lift heavy objects below the shoulder level.
- Lift heavy objects close to your body.
- Avoid push-ups, bench presses, and shoulder press exercises if painful.
- Maintain a good posture.
- Swim with a sidestroke or breaststroke.
Seeking Treatment for your Shoulder Pain
If resting or over-the-counter medications aren’t relieving your shoulder pain, consulting with a doctor is the next logical step. Our shoulder experts at Orthopedic & Laser Spine Surgery want to help you pinpoint the source of your pain and provide you with the most appropriate treatment.
Our dedicated team offers a comprehensive program using only the latest technology and treatments. If surgery is an option for you, then we specialize in minimally invasive techniques that will make your recovery period shorter. Schedule a consultation now to receive an accurate diagnosis or a valued second opinion!
Do you ever notice a pop or snap in your hip? Certain movements may cause the sound or sensation as a hip tendon or muscle slides over the bone. This condition is commonly known as snapping hip syndrome (SHS). It can also be referred to as dancer’s hip or as coxa saltans.
In many cases, SHS is not a cause for concern. Often painless, it’s more of a nuisance than anything else.
There are certain times, however, when getting treatment will help ease any pain and prevent more serious complications.
So why does the hip snap? The hip’s anatomy is a great place to start taking a look.
Understanding the Hip
As one of the largest joints in the body, the hip joint is an important weight-bearing structure. It allows you to walk, jump, run, and perform various lower body movements. When healthy, it is one of the most flexible joints in the body.
The top of your thigh bone fits into a cup-shaped socket in the pelvis. This ball-and-socket joint uses ligaments to keep everything in place. Above the ligaments, tendons attach muscles in the buttocks, thighs, and pelvis to the bones. A very slippery liquid, known as synovial fluid, protects the bones and helps the joints to flex.
These layers of protection make your hip one of the most durable, stable joints in the body. Unfortunately, even with all its protection, the hip may suffer injury.
What Causes the Hip to “Snap”?
When tendons or muscles slide over the bony knobs of the hip, snapping occurs. This can affect various areas of the hip. These areas include:
Outside of the Hip
Known as external snapping hip syndrome, this occurs when a tendon or muscle slides over the bony knob on top of the thigh bone. This bony mass, known as the greater trochanter, can either catch on the iliotibial band or on the gluteus maximus muscle.
This is typically caused by muscle tension in the iliotibial band or gluteus maximus. You may notice the snapping when climbing stairs, running, or carrying heavy loads like shopping bags. Some may feel a sudden, sharp pain outside the hip.
Inside the Hip
Referred to as internal snapping hip syndrome, this involves the sliding of tendons or muscles over bony structures at the front of the hip joint. The two common hip flexors involved are the iliopsoas tendon connecting to the iliopsoas muscle and the quadriceps muscle known as the rectus femoris.
You may notice internal snapping when getting up from a chair, running, or rotating the legs away from the body. Sometimes this condition causes sudden pain, deep inside the groin area.
Injury to Hip Cartilage
When the cartilage protecting the hip socket tears or gets injured, snapping may occur. This is usually due to a sudden trauma like falling or chronic conditions like hip arthritis. Damaged cartilage usually causes pain and the hip joint to lock up.
Symptoms of snapping hip syndrome can range from mild irritation to dehabiliting pain. Common symptoms include:
- Popping or snapping in any area of the hip when rotating, lifting, lowering, or swinging the leg.
- Leg weakness when making forward or sideways movements.
- Swelling or tightness in the side, front, or back of the hip.
- Problems walking, running, exercising, or getting up from a chair.
- Feeling like the hip will detach from the socket.
- Locking up of the hip when performing certain movements.
Risk Factors for Snapping Hip Syndrome
Just about anyone can develop this condition, but there are certain factors that make snapping hip syndrome more likely. These include:
- Athletes and others who regularly recruit extreme range of motion in the hips, such as ballet dancers, those who practice martial arts, and football players.
- Young athletes who are going through growth spurts.
- Those with arthritis or other chronic conditions that affect the hips.
- People who are recovering from knee or hip surgeries.
- Those with jobs that involve frequent bending at the hips.
- People who dramatically increase their activity level or exercise routines.
Treatment for Snapping Hip Syndrome
For many, a snapping hip isn’t much cause for concern. Others may experience pain because of this condition, making treatment a necessity. Pain occurs when the snapping tendon or muscle becomes inflamed or injured, usually over time. In addition, the snapping can irritate a fluid-filled structure that helps to lubricate the bone and soft tissue. The inflammation of this structure, known as hip bursitis, can be quite painful.
In many cases, conservative treatments can help to reduce pain. These include:
- Resting the Area: Athletes and others with this condition can take a short break from the motions that cause the irritation. This helps the muscles, tendons, and other structures to recover.
- Anti-Inflammatory Medicine: Over-the-counter aspirin or ibuprofen can relieve pain and reduce swelling in the affected areas.
- Physical Therapy: A physical therapist can stretch and massage the area, helping to relieve any muscle tension. In addition, your therapist can suggest modifications to your everyday activities that allow your hip to rest.
- Corticosteroid Injection: If the pain prevents you from engaging in your daily activities, a physician may prescribe a steroid injection to reduce the inflammation.
These treatments have an excellent chance of improving your condition. If you’re still not experiencing relief, however, then other options are still available.
Surgical Treatments for Snapping Hip Syndrome
In rare cases, a surgical treatment may be the best answer to resolve your pain. After a full medical evaluation and diagnostic imaging, an orthopedic surgeon may recommend one of the following procedures:
- Iliopsoas Tendon (IT) Release: Typically used for internal snapping hip syndrome, a surgeon makes strategic cuts in the IT band to reduce tension and lengthen it. This should decrease (or even stop) the snapping.
- Hip Arthroscopy: The surgeon inserts a tiny camera into your hip joint to find and remove loose pieces of cartilage that have become caught in the ball-and-socket joint.
- Acetabular Labrum Repair: If imaging tests determine a tear in the ring of cartilage on the outside rim of the hip joint (labrum), then your surgeon can use a tiny camera and instruments to repair the damage.
In many cases, these minimally invasive procedures will eliminate the snapping and pain caused by this condition.
When Surgery is Necessary…
Although snapping hip syndrome rarely requires surgery, consulting with a qualified orthopedic surgeon can provide solutions to help ease your pain and get your life back on track.
Our experts at Orthopedic & Laser Spine Surgery believe that you can return to a pain-free life. Our team is ready to meet with you, review any previous MRIs or imaging results, and determine the best course of action for your pain. From nagging pain to sports medicine issues, we will help you pinpoint the source of your hip pain and find the best solutions.
Calling the Orthopedic & Laser Spine Surgery clinic may be the next step in getting your life back. Our surgeons are leaders in their fields, with decades of experience in helping others. Don’t hesitate to call or schedule an appointment today!
An Epidural Steroid Injection (ESI) is commonly used to treat inflammation in the lower back, as well as any related neck and leg pain. In these conditions, spinal nerves become inflamed as the passages where these nerves travel down the spine begin to narrow. (ESIs) can resolve that pain. In addition, your doctor can also use (ESIs) to diagnose which nerves in the spine are causing problems.
Normally, your doctor will inject (ESIs) into the lower back in sets of 2 or 3. This helps to reduce pain, as well as strengthen the lower back. It is important to note that (ESIs) are meant to manage lower back pain, not cure it. With that said, a patient’s mobility will improve and their back will heal quicker because of the decrease in pain. The injections only take less than a minute to administer. And, the performing physician will often follow up an (ESI) with an immediate examination.
How are Epidural Steroid Injections (ESIs) Performed?
Your physician can deliver the steroid into the epidural space through three methods: the caudal, interlaminar, and transforaminal approaches. The common trend between these methods involves placing a needle through the use of fluoroscopic guidance. Before you receive the injection, a nurse or doctor will thoroughly clean the treatment area. Contrast dyes are used to ensure that the steroid travels to the correct area. In many cases, your doctor will use a local anesthetic along with the steroid to make the process less painful for the patient.
The interlaminar approach involves placing the needle into the back of the epidural space, which allows for your doctor to deliver the steroid over a wider area. The caudal method is not too different, injecting the needle in a small boney opening just above the tailbone. This allows for your doctor to place the needle into the bottom of the epidural space. Using these methods, the steroid will spread over multiple spinal segments which allows for the medication to reach both sides of the spinal canal. With transforaminal (ESIs), or nerve blocks, the needle is placed beside the nerve as it leaves the spine. After which, medication is placed into the nerve sleeve, which then travels up into the epidural space from the side. Using this method, a concentrated dose of the steroid can seep into the affected area.
These (ESIs) can be performed on an outpatient basis, allowing the patient to return to their previous activities the following day. Patients can request mild sedation for the procedure, but most just stick with local anesthesia.
What To Expect
(ESIs) normally begin working within 1-3 days following treatment. However, in rare cases, it may take up to 7 days for you to feel pain relief. Most patients tolerate the injection very well and experience only mild side effects, which resolve within a few days. Diabetics and those with allergies to contrast dyes should discuss these conditions with their doctor before receiving an (ESI).
(ESIs) have been performed for many years and are considered a safe and effective treatment for neck, back, leg, and arm pain. Serious complications are rare and minimized through the use of x-ray guidance. Overall, most patients tolerate (ESIs) very well.
Injections can provide patients with improvement in both pain and function for several months or longer. If the patient notices significant relief, then your physician can repeat these injections without risk to maintain these improvements. (ESIs) are commonly used with other treatments, such as medications and physical therapy, in order to maximize their effects.
Am I A Candidate For An (ESI)?
Patients with low back, neck, arm, or leg pain may benefit from an (ESI). Most commonly, orthopedists use this treatment to address the following conditions:
- Herniated Disc: Irritation, pain, and swelling caused by the gel-like material within spinal discs squeezing out and coming in contact with spinal nerves.
- Sciatica: Pain in the sciatic nerve that travels from the buttocks and down to the legs. Compression of the 1st sacral nerve and the 5th lumbar nerve often leads to this condition.
- Degenerative Disc Disease: Breakdown/aging of vertebrae caused by collapsing disc spaces, annular tears, and bone spur growth.
- Spinal Stenosis: Back and leg pain caused by the narrowing of the spinal canal as well as the nerve root canal.
- Spondylolisthesis: Caused by vertebral fractures/weaknesses that lead to the vertebrae slipping forward and compressing nerve roots
(ESIs) are particularly helpful in treating painful inflammatory conditions. Doctors also use (ESIs) for diagnostic purposes, such as determining whether surgery could help the pain associated with a herniated disc.
In addition to people with diabetes and pregnant women, these injections should not be performed on patients who have bleeding problems or an infection.
What Happens After Treatment?
Patients will be able to walk around directly after receiving an (ESI). Usually, doctors will observe the patient for a short time before allowing them to leave the center. Rarely, temporary numbness or weakness can occur in the legs. So, your physician will advise that you bring someone along who can take you home afterward.
You should be able to resume full activity the next day. However, you may notice some soreness around the treated area, but you can easily treat this by using ice and OTC medicines such as Tylenol. Your doctor will recommend that you keep track of your pain levels as the numbing medicine wears off and the (ESI) takes effect.
Patients may want to schedule a follow-up visit with their doctor to address any and all concerns.
Are you considering an (ESI) for your treatment? If so, contact our board-certified spine and orthopedic experts at OLSS. Our practice has clinics in Florida, New Jersey, and New York, as well as a team of award-winning experts whom you can trust.