If you have had back or neck pain you may have had epidural steroid injections as a treatment for your pain. There has been a surge in the number of epidural injections performed over the past several years, but we continue to evaluate a large number of patients who have not improved with this type of treatment. It is our opinion that this failure is because epidural steroid injections cannot offer a cure, because of what they are and the philosophy on which they are based. We will explain this opinion below.
As you can see in the pictures above, the nerve roots exit the spine through the spaces between the bones and continue down the arm or the leg to supply each part of the limb with sensation and strength. Around each nerve is a protective covering called the dura. The dura is not attached to any of the vertebrae or discs or ligaments. There is a space around the dura and nerve, called the epidural space. This is where the epidural injections are placed.If the nerve root is diseased, there is a cause, i.e. the abnormality came from somewhere. However, with epidural injections the medication is placed in an empty space. This is the reason these injections cannot offer a cure for your condition. If we want to treat a problem, we must treat what is causing the problem. For example if someone has pneumonia, we want to culture the bacteria and give an antibiotic, not just cover the symptoms with anti-cough mediations. This same philosophy holds true with epidural steroid injections: we must treat the cause of the problem, not cover over symptoms. There can be no cure without treatment of the offending structure. Placing medication in an empty space is useless.
If the nerve root is diseased as it exits the spine it causes changes that are found throughout the entire distribution of that nerve. For example, the nerve that exits between the last lumbar vertebra and the sacrum will show abnormalities in all the muscles of the front of the calf. These abnormalities can only be found on electrodiagnostic examination, the electromyogram or EMG. An MRI does not and cannot provide this type of information—it is strictly a detailed picture. It cannot tell what is painful and what is not. For example, 30% of people without back pain will have “herniated discs”, what is usually deemed the cause of people’s pain. All too often however people have epidural injections without a preceding EMG. We believe this is the absolute wrong way to achieve any kind of pain relief.
Join us for these future speaking engagements, when we will explain our approaches and answer your questions regarding your painful condition.
Monthly pain seminar on a variety of topics
- Headache/Neck pain
- Arthritis
- Physical Therapy and Modalities
- MRI Findings