Treatment of pain in lumbar disc herniation by injection of epidural corticosteroids through the foramen

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Post by Master, Doctor Truong Van Tri - Head of Functional Neurosurgery Unit - Department of General Surgery - Vinmec Central Park International General Hospital

Pain from lumbar disc herniation is becoming more and more common. This condition not only limits the function of the disc, but also reduces the quality of life of the patient. Treatment of pain in lumbar disc herniation by means of epidural corticosteroid injection through the foramen magnum has become a widely applied treatment method. Refer to the article below to better understand this method.

1. In what case is epidural corticosteroid injection indicated?

Epidural glucocorticoid injection is often indicated for patients with leg or back pain caused by lumbar disc herniation, spinal stenosis, or lateral recess. This method helps reduce pain and improve mobility without surgery. This is an attempt to avoid the patient having an operation after other conservative treatments have failed.

2. Implementation steps

Under the guidance of the X-ray monitor, a fine needle is inserted into the foramen fascia (where the nerve root exits from the spinal canal) (Figure 1).

Hình 1. Tiêm thấm ngoài màng cứng qua lổ liên hợp (nguồn: completepaincare.com)

Contrast injection and X-ray to confirm that the drug is injected into the desired location (Figure 2) before injecting corticosteroids. This method allows the drug to reach the stimulated nerve root better than epidural corticosteroid injection through the spinal space.

Hình 2. Xquang cho thấy thuốc cản quang thấm tốt quanh rể thần kinh và khoang ngoài màng cứng (nguồn: spineuniverse.com)

3. Success rate of epidural corticosteroid injection method through the conjugate hole

Research shows that the success rate of this method is 71-84% and usually reaches its maximum effect by the 6th week after injection. It has been reported that 75% of patients have reduced leg pain and 64% of patients have improved walking ability at 1 year after injection.
The injections can be repeated. Research shows that a second shot can help improve pain if the first shot only provides partial pain relief. Patients should wait at least 2 weeks before evaluating and deciding on a second injection. In 1 year, patients can have 3-6 injections, the best interval between injections should be 3-6 months.

4. Complications

During the injection process, some patients may experience dizziness, lightheadedness, and hypotension, but these symptoms are transient.
After the injection, the patient may have headache, dizziness or numbness in the legs, these symptoms usually disappear after a few hours. Patients may have difficulty sleeping the first few nights following the injection. Blood sugar may increase. Complications such as infection, bleeding, discomfort at the injection site, and nerve damage are rare.
According to experts, after the injection, patients should limit movement and rest for the first 24 hours. Then you can return to your normal activities.

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References
Bodguk N. Practice Guidelines for Spinal Diagnostic and Treatment Procedures, 2nd edition. International Spine Intervention Society, Sanfrancisco, 2013 Novak S, Nemeth WC. The basis for recommending repeating epidural steroid injections for radial low back pain: a literature review. Arch Phys Med Rehabil 2008;89:543-52. Murthy NS, Geske JR, Shelerud RA, et al. The effectiveness of repeat lumbago transforaminal epidural steroid injections. Pain Med 2014;15:1686-94.

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