Below are links to articles posted in July, 2018
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.
The spinal cord links the brain to all other parts of the body. When an abnormal growth, otherwise known as a tumor, appears on the spine it can be painful and dangerous. By knowing the warning signs of a spinal tumor, you have a better chance of early diagnosis and exploring appropriate treatment options.
Understanding the Spinal Column and Spinal Cord
The spinal cord serves a key role in the central nervous system (CNS). This long cylinder of nerves starts at the brain and runs through the spinal column. Since the brain controls our thoughts, movements, and interprets our external environment, it needs a way to communicate. This series of nerves in the spinal cord allows the brain to communicate with the rest of the body.
How important is this communication? Well, it’s is keeping you alive and moving. The CNS controls voluntary movements like talking, walking, and eating. It also controls involuntary functions like breathing, interpreting sensations, and digestion.
The spinal column is a series of bones, known as vertebrae, starting from the base of the skull to the backbone. In addition to protecting the spinal cord, it supports the upper body’s weight and helps with flexibility, movement, and posture.
In addition to the 33 bones of the spine, the spinal column has thin layers of cartilage known as discs. These discs prevent the vertebrae from rubbing together and also support the body’s weight. Small spaces, known as intervertebral canals, allow spinal nerves to exit the spinal cord and reach different areas of the body.
Types of Spinal Tumors
As you probably know, tumors are abnormal masses of tissue. They grow uncontrollably despite the body’s best efforts to destroy them. While some causes of tumors are unknown, others may be a result of exposure to cancer-causing agents or genetics.
A vertebral column tumor can be either primary or secondary. A primary spinal tumor develops in the spinal cord or column. In many cases, these tumors are benign–or not cancerous. These tumors don’t usually spread to other parts of the body. A secondary spinal tumor occurs when cancers from other parts of the body spread (or metastasize) to the spine. These malignant (cancer-filled) tumors often start in the lungs, breasts, or prostate.
Doctors also classify spinal tumors based on their location. The 3 basic types of spinal tumors include:
- Intramedullary tumors: Growths that occur inside the spinal column. These usually occur in the cervical, or neck, region.
- Intradural-extramedullary tumors: Growths that develop outside of the spinal cord but inside a spinal canal membrane called the dura mater.
- Extradural tumors: Growths that start outside the dura mater, usually in the bones around the spinal cord. This is the most common type of spinal tumor.
What are the Signs of a Spinal Tumor?
The signs and symptoms of a spinal tumor vary. It typically depends on the type of tumor and its location. One of the most common signs of a spinal tumor is back pain. Of course, back pain isn’t always caused by a tumor. In fact, muscle or ligament strain, bulging discs, arthritis, and other issues with the vertebrae may be the source.
Back pain not due to activity or muscle strain, however, may be caused by a spinal tumor. This is especially true if the back pain gets worse at night and medications don’t seem to lessen the pain.
If a spinal tumor presses on the spinal cord causing spinal stenosis, certain neurological symptoms may occur. These include numbing or loss of sensation, muscle weakness, and trouble walking. Tumors in the neck region tend to affect the arms. In contrast, tumors in the lower and mid-back may affect the legs and chest.
Some of the more severe signs of a spinal tumor include trouble controlling the bladder or bowels, partial paralysis, and scoliosis (sideways curvature of the spine).
If you suspect any of your symptoms could result from a spinal tumor, it is important to consult with a doctor right away. Early diagnosis and prompt treatment often lead to better outcomes.
Diagnosing a Spinal Tumor
Thanks to modern imaging technology, diagnosing a spinal tumor is easier than ever. After a doctor reviews your medical history, current symptoms, and performs a thorough physical exam, the next step typically involves taking images of spine. Imaging occurs in a couple of different ways. These include:
- X-Rays: Although x-rays aren’t the most reliable way to diagnose tumors, they provide an image of the bones in the spine. This can help to rule out fractures and some infections.
- Computed Tomography Scan (CT): CT scans use computer technology and x-rays to create a cross-sectional image of the spine. This helps to get a better idea of the size and shape of the spinal canal.
- Magnetic Resonance Imaging (MRI): This test creates a 3D image of the spine. Unlike x-rays, these images show the soft tissues of the spinal column like the spinal cord, nerve roots, and tumors.
In addition to diagnostic images, doctors may order a blood test to determine if there is cancer in your system.
Once a doctor locates a tumor, a biopsy generally comes next. Depending on the location of the tumor, the doctor performs a minimally invasive procedure to sample a small piece of the tumor. The doctor then examines the tissue under a microscope to determine if it contains cancer cells.
Treatment Options for Spinal Tumors
Research has shown the best approach to battling tumors often uses a combination of treatments. The type of treatment varies based on the kind of tumor, where it is located, and your current health condition.
A primary spinal tumor may only require monitoring to keep track of any growth. In other cases, however, radiation therapy or chemotherapy may be necessary. Some smaller, non-cancerous tumors can also be removed with minimally invasive surgery.
A secondary spinal tumor presents other challenges since cancer from another area has spread to the spine. Some patients may respond to radiation only. Others may require a combination of radiation, chemotherapy, and surgery.
Surgery may be necessary to remove all or part of the tumor. It can also be used to stabilize the spine if the tumor caused any damage.
Hospital stays for spinal tumors can last 5 to 10 days. After surgery, rehabilitation, like physical or occupational therapy, helps with recovery and regaining function in the body. Total recovery varies depending on the type of surgery and how your body responds.
When Spinal Surgery is Necessary…
Operating on the spine is serious business. You want the comfort of knowing the most trusted experts in the field are taking care of you.
Orthopedic & Laser Spine Surgery (OLSS) has an award-winning team of experts specializing in multiple treatment options, including minimally invasive surgery. The surgeons at OLSS have the training, experience, and technology–boasting a 95% success rate for their treatments.
If you’re seeking a diagnosis for your pain or want a second opinion, see how the team at OLSS can help. You can even bring in your previous MRIs for a free review. Now is the time to find the best solution to get your life back on track!