Are Caudal Epidural Shots Good For Chronic Lumbar Sciatica?
Individuals who are doing with chronic sciatica often end up undergoing epidural steroid shots for pain relief. There are actually 3 different types of epidural steroid injections that people may undergo.
These 3 different types of epidural injections work by reducing inflammation and swelling of the pinched nerve roots in the area around the dural sac, which is commonly known as the epidural space.
The 1st type of injections in the epidural space has been used for decades and is called an interlaminar epidural injection. In the past these were performed without the guidance of x-rays simply by physicians using feel in an office setting.
Some physicians still do epidural injections without x-ray guidance however research has shown that without the guidance 30% of the time the shots miss the epidural space. So most pain management Phoenix doctors in the current day and age do you use a form of real-time x-ray, which is known as fluoroscopy.
With interlaminar epidural injections, the steroid is placed in the epidural space right over the dural sac, which is an inexact science. Most of the time, the nerve root that is being compressed is actually being pinched as it exits from the epidural space. So the steroid that is injected actually has a bit of a ways to travel to reach the area of the problem.
The 2nd type of epidural injection it is called a transforaminal steroid injection. This has surged in popularity over the last 10 years and allows pain doctors to put the steroid much closer to the area where the nerve root is actually being compressed.
The cortisone injected can reduce swelling and inflammation around the pinched nerve with its hefty anti-inflammatory action. Medications that numb such as lidocaine are also often placed which can help disrupt the pain cycle with the steroid providing significant pain relief.
The 3rd variant of epidural injections is called a caudal injection with the needle being placed through the sacral hiatus and a large volume of both steroid and numbing medicine is then injected.
This is an inexact science with the hope being that the injection of a large amount of medication will seep into the problem areas where nerve roots are being compressed. There is some literature showing that caudal epidural steroids can work very well for acute lumbar radiculopathy.
A new study that was published by the Massachusetts Medical Society looked at treatment of chronic lumbar radiculopathy by caudal epidural steroid injections. This trial was performed in Norway and looked at caudal epidural steroid injections versus saline injections in patients who had over 12 weeks of lumbar radiculopathy..
People followed for a year after the injections. After that half of the patients reported feeling a lot better and only 27% had persistent sciatica.
There was not a statistical difference between the outcomes in the steroid group versus the control group with saline. Therefore the conclusion was that caudal epidurals were actually not an effective treatment for chronic sciatica.
Therefore based on this study the better course of action would be to utilize one of the other epidural steroid injection types of chronic sciatica. This would mean either using the interlaminar or transforaminal varieties at a pain clinics in Arizona.
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Tags: epidural steroid injections, herniated disc, pinched nerve, Sciatica Treatment