Epidural Steroid Injections for Sciatica

Non-Surgical Methods Spell Relief for Many Sufferers

Navid Farahmand, MD

Epidural Steroid Injections as a treatment for Sciatica pain are one effective way for sufferers to find considerable relief. or irritation or impingement of one or more of the nerves contributing to the sciatic nerve, is a common problem. It can be debilitating and can cause missed days from work, recreation, life events with friends and family, and is even a common problem seen in the emergency room of local hospitals. The good news is that there are several forms of treatment for sciatica, including physical therapy, spinal decompression and in the most difficult cases, surgery. But one of the most effective non-operative forms of treatment is the administration of steroids onto the effected spinal nerves, often times referred to as an epidural steroid injection for Sciatica.

The source of the problem with sciatica pain is usually found in the spinal nerves of the low back, also referred to as the lumbar spine. These spinal nerves exit the spine and ultimately travel down the leg, giving signals that communicate both sensory information such as touch, position, and temperature, as well as motor signals that allow the muscles to contract. These spinal nerves are largely effected in one of two ways.

First and perhaps most commonly, these nerves can be irritated by disc bulges that push backwards and exert mechanical pressure on the nerves in the spinal canal. With less space in which to live and move, the spinal nerves can detect the increased pressure, triggering an inflammatory cascade which produces pain signals. Steroids such as triamcinolone and dexamathesone (amongst many others) deposited on the affected nerve(s) during an epidural steroid injection help stop the inflammatory cascade in its path, resulting in sciatica pain relief.

A second and slightly less common cause for sciatica that can be successfully treated with an epidural steroid injection is a chemical irritation of the spinal nerves. The discs, which serve to create a bumper or cushion between the lumbar vertebrae, can tear from a number of causes including trauma and degeneration. When the tear extends all the way to the periphery of the disc, it is called an annular tear. As a result of an annular tear, specific pro-inflammatory proteins and chemicals found within the inside of disc can make their way out through the tear, causing a chemical inflammation of the spinal nerves and sometimes resulting in sciatica.

Again, introduction of anti-inflammatory steroids onto the effected spinal nerves via an epidural steroid injection can help to dampen or extinguish the inflammatory signal.

An epidural steroid injection should be administered by a fellowship-trained interventional pain specialist. A specialist of this caliber has undergone a year or more of additional training to focus specifically on various types of procedures that use x-ray guidance (also referred to as fluoroscopy) to perform the epidural steroid injection procedure for Sciatica. Your interventional specialist is trained to safely and comfortably guide the needle down to the target nerve(s) and inject the steroid medication directly on the source of the problem. There is more than one way to perform an epidural steroid injection, and depending on your specific problem and complaints, your doctor will help you determine which route is likely to be best for your specific Sciatica pain relief needs.

Common questions regarding epidural steroid injections in the treatment of sciatica include:

  1. How quickly can a patient expect to see pain relief results? It depends on the medication used and how bad the problem is to begin with, but most people have some benefit immediately, which is expected to improve over the course of several days to weeks.
  2. How often can the procedure be done, if necessary? General guidelines state that if possible, epidural steroid injections should be limited to three injections in a twelve-month period, as there are some risks associated over-use of steroids long-term.

A consult with an interventional specialist about your sciatica symptoms will include a review of epidural steroid injections, as well as the other treatment options that may benefit you.