Indications for Epidural Injections
Several common conditions that cause severe acute or chronic low back pain and/or leg pain (sciatica) from nerve irritation can be treated by steroid epidural injections. These types of conditions include:
- A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves.
- Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back.
- Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain.
- Compression fractures in a vertebra.
- Cysts which are in the facet joint or the nerve root and can expand to squeeze spine structures.
- Annular tear, a painful condition where a tear is present in the outer layer of the disc.
For these and many other conditions that can cause low back pain and leg pain, an epidural injection may be an effective non-surgical treatment option.
Who Should Avoid Epidural Injections
Several conditions could preclude a patient from having a back pain injection:
- Local or systemic infection
- Pregnancy (if fluoroscopy, a type of x-ray, is used)
- Bleeding problems - patient taking blood thinners (Coumadin, etc), or patients with a bleeding problem (hemophilia, etc)
Back pain injections should also not be performed on patients whose pain could be related to a tumor. If suspected, an MRI scan should be done prior to the injection to rule out a tumor.
Epidural injections may be done, but with caution, for patients with other potentially problematic conditions such as:
- Allergies to the injected solution
- Uncontrolled medical problems such as renal disease, congestive heart failure and diabetes because they may be complicated by the fluid retention that a small percentage of patients experience for a few days after the injections
