Disc disc treatment by injection, as this is one of the latest methods of pain relief in Turkey and often avoids surgery. It can also be used before operation laser.
Epidural steroid injection (ESI).
It is a minimally invasive procedure that can help relieve neck, arm, back and leg pain caused by spinal neuritis due to spinal stenosis or disc herniation.
The drugs are delivered to the epidural, the fat-filled area between the bone and the protective sac of the spinal nerves.
Where pain relief may last for several days or even years.
The goal is to reduce edema around the nerve and thus reduce pain so that you can resume normal activities and a physical therapy program.
Who is a candidate for ESI for herniated disc treatment?
Patients with pain in the neck, arm, lower back, or leg (sciatica) may benefit from ESI who have the following conditions:
- Spinal stenosis (spinal stenosis): Narrowing of the spinal canal and nerve root canal can lead to back and leg pain, especially when walking.
- Spondylolisthesis: Weakness or fracture between the upper and lower sides of the vertebra.
If the vertebra slides forward, it can compress the nerve roots, causing pain.
- Herniated disc: The gel material inside the disc can bulge or rupture, resulting in irritation, pain and swelling when this material compresses and makes contact with the spinal nerve.
- Degenerative disc: the breakdown or aging of the intervertebral disc resulting in the breakdown of disc space, rupture of the annulus, and the growth of bone spurs.
- Sciatica: Pain that flows along the sciatic nerve in the buttocks and down the legs.
It is usually caused by compression of the fifth lumbar or first sacral nerve.
ESI has also proven useful for some patients in the treatment of painful inflammatory conditions.
ESI can also help determine whether Disc surgery Useful for pain associated with a herniated disc or not.
When symptoms increase with rehabilitative exercises (physiotherapy), epidurals can relieve pain enough so that patients can continue physical therapy.
ESI should not be performed on people who have an infection or have bleeding problems.
The injection may cause a slight rise in blood sugar levels in people with diabetes. It may also temporarily raise blood pressure and eye pressure in glaucoma patients. You should discuss this with your doctor.
If you think you are pregnant, tell your doctor. X-ray fluoroscopy may be harmful to a baby.
What happens before treatment?
The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best injection method.
Patients taking blood-thinning medications (Coumadin, Plavix, etc.) may need to stop taking it several days before the ESI. Discuss all medications with your doctors.
The procedure is usually performed in an outpatient center using X-ray endoscopy. Make arrangements to have someone drive you to and from the center on the day of the injection.
What happens during treatment?
At the time of the procedure, you'll be asked to sign consent forms, a list of medications you're currently taking, and if you have any drug allergies. The operation may take 15-45 minutes, followed by a recovery period.
The goal is to inject the medication as close to the painful nerve as possible. The type of injection depends on your condition and whether you have metal rods or screws from previous surgery. Your doctor will decide which type is most likely to produce the best results.
Step one: prepare the patient
The patient lies on the X-ray table.
Local anesthesia is used to numb the treatment area so that pain is minimal throughout the procedure. The patient remains awake and conscious during the injection to provide feedback to the doctor.
Low-dose oral analgesics, such as Valium or Versed, may be given, depending on the center.
The second step: insert the needle
With the help of an X-ray endoscope, the doctor guides a hollow needle through the skin and between the bony vertebrae into the epidural space.
Fluoroscopy allows the doctor to monitor the needle in real time on an X-ray monitor, ensuring that the needle travels to the desired location.
Some pain occurs during the procedure, but in general patients usually feel more pressure than pain.
There are several types of ESIs:
- ESI Treatment of cervical disc disc by injection: The injection site for the needle is located from the side of the neck to reach the site of the nerve, just above the opening of the nerve root and outside the epidural space.
A dye is injected that appears on a fluorescent machine to confirm where the drug is flowing.
- lumbar ESI (Lower Back): The needle entry site is slightly off the midline of the back to reach the neural canal.
A dye is also injected to confirm where the drug is flowing.
- caudal ESI (Sacral): The needle is placed in the sacral space above the sacral bone to access the lowest spinal nerves.
A contrast dye is injected to confirm where the medication is flowing.
Step Three: Inject the medicine
When the needle is positioned correctly, anesthetics and corticosteroids are injected into the epidural space around the nerve roots.
Then the needle is removed. Depending on the location of the pain, the procedure can be repeated for the left and right sides.
One or several levels can be injected into the spine.
Sedatives and/or anesthesia may be used
If needed, relaxation medication may be given through an intravenous (IV) line in the patient's arm, but the patient is usually conscious during this procedure.
The treatment area in the lower back is numbed with a very thin local anesthetic injection before the epidural is given, so the epidural injection procedure is usually painless.
An epidural steroid injection may take about 15-45 minutes to complete.
A slight tingling, burning, or pressure feeling may be felt when the medication enters the epidural space. When the injection is complete, the irritation and discomfort usually disappear within a few minutes.
Patients usually go home after a few hours.
Specific precautions are taken after the injection for the next few days.
Possible benefits of an epidural steroid injection
Most doctors agree that an epidural can be helpful during an acute attack of back and/or leg pain.
The main disadvantages of injections are that they are not always effective, and when they are effective, the pain relievers tend to be temporary, ranging from a week to a year.
Usually, if the initial injection is effective, up to 3 injections can be given in one year.
When a lumbar epidural steroid injection is given, the steroid injection may have the following benefits:
- Reduce nerve pain and inflammation. Steroids reduce the production of inflammatory chemicals and reduce the sensitivity of nerve fibers to pain, resulting in fewer pain signals.
- Minimize oral medication. Pain relief from these injections may help reduce or eliminate the need for oral medications, and some may have side effects when taken long-term.
- Continuing or re-engaging in physical therapy. This injection may provide sufficient pain relief to allow the patient to progress into a rehabilitative physical therapy program.
- Postponing surgery. Pain relief from a lumbar epidural steroid injection may help delay surgery and, if physical therapy is effective, eliminate the need for surgery.
Several techniques can be used to treat an epidural disc disc depending on the underlying condition, the patient's needs, and the physician's preference and experience.
Available research indicates generally positive results, with 70% to 90% of patients enjoying pain relief from these injections, lasting for a week to a year.
If a good first response is seen, a second injection may be considered when the improvement from the first injection begins to diminish. Usually, up to 3 injections can be given over a 12 month period.
While several studies have documented the short-term benefits of epidural steroid injections, data regarding long-term efficacy are less convincing.
Controversy continues over its effectiveness in reducing pain and improving function. Studies supporting and opposing them are provided below.
In addition, there are several limitations in the research that has been conducted, such as:
- Many studies do not include the use of fluoroscopy or X-rays to check the appropriate placement of medication despite the fact that fluoroscopy guidelines are used routinely today.
- Other studies do not classify patients according to diagnosis and tend to "group" different types of pain sources together.
These methodological flaws tend to limit the usefulness of the research. More studies are needed to determine the role of epidural steroid injections in low back pain and sciatica.
Who does the injections in the process of herniated disc, the fourth and fifth paragraphs?
Doctors who perform this type of injection include neurosurgeons or anesthesiologists and pain specialists. The injection is usually done in a surgery center, hospital, or doctor's office.
Possible risks and contraindications for epidural injections for a herniated disc between the fourth and fifth vertebrae.
Epidural steroid injections are relatively safe and minimally invasive. Temporary side effects may occur in some cases and include (but are not limited to):
- Post-injection pain
- fainting (vasovagal syncope)
- redness in the face
These side effects usually resolve within a few minutes to hours. Serious complications, although rare, may include damage to the spinal cord, perforation of the dura and/or stroke.
Possible complications and adverse events after epidural steroid injection
While serious complications are rare after epidural steroid injections, they are mentioned in detail.
The infection may occur generally within the body (systemic infection), affect the brain and/or spinal cord, or occur locally at the injection site. Examples include:
Epidural abscess: accumulation of pus in the epidural space.
Meningitis: inflammation of the membranes of the brain and spinal cord.
Osteomyelitis or intervertebral disc: Inflammation of the bones of the Euphrates or the disc between the vertebrae.
Soft tissue abscess: accumulation of pus within the soft tissues at the injection site.
Microbes from the patient's skin are believed to be a common cause of infection.
- Bleeding after disc treatment with injection
Arterial injury may cause local hemorrhage and blood pooling within the soft tissue, epidural space, or spinal cord membranes. A hematoma or blood clot may form within the artery, blocking the blood supply to vital tissues, such as the brain and/or spinal cord.
- dura hole
Inadvertently inserting the needle into the outer membrane of the spinal cord (dura mater) may result in a perforation of the dura. Also called cerebrospinal fluid leakage, this condition causes cerebrospinal fluid to leak, which lowers the pressure of the cerebrospinal fluid in the brain, causing headaches and headaches that go away with pain relievers.
- nerve damage
Damage to nearby nerves may cause abnormal sensations, loss of sensation, or seizures. If the cauda equina nerves at the base of the spinal cord are damaged, it can lead to a medical emergency called cauda equina syndrome.
This syndrome causes loss of bowel and bladder control and must be treated immediately to prevent paralysis of the lower body.
- Cardiovascular (heart) complications
Sometimes, low blood pressure and low heart rate may occur after an epidural steroid injection.
- Risks Associated with Local Anesthesia
In injections containing a local anesthetic, if the solution enters a blood vessel, it may poison the central nervous system and/or the cardiovascular system.
- Risks Associated with Particulate Steroids in Injectable Disc Treatment
Larger particles in the molecular activators may clump together and clog blood vessels, resulting in reduced blood flow to the spinal cord.
The risks and complications are usually higher with epidural steroid injections given above the L3 level, and the most common risks are injections of steroids into the blood vessels, which are more likely to occur in people over 50 years of age.
In rare cases, an allergic reaction to steroids, local anesthetics, or the dye may occur.
Less risks in the spinal levels L4 and below.
In general, epidural injections given at spinal levels L4 and below carry a lower risk of complications compared to higher levels. The injection is usually done under fluoroscopy (X-ray guidance) using a contrast dye. Fluoroscopy helps guide the needle to the exact site and helps prevent nerve and/or artery damage.
What happens after treatment of lumbar disc herniation by injection?
Most patients can walk around immediately after the procedure.
After you have been observed for a short period, you can usually leave the position.
Rarely, temporary leg weakness or numbness may occur; So someone has to drive you home.
Patients usually return to their full activity the next day. Pain around the injection site can be relieved with ice and a mild analgesic (Tylenol).
You may want to record your pain levels for the next two weeks in a notebook. You may notice a slight increase in pain, numbness, or weakness as the narcotic medicine wears off and before the corticosteroid takes effect.
Patients should schedule a follow-up appointment with their referring physician or therapist after the procedure to document efficacy and address any concerns the patient may have about future treatments and expectations.
When do you call the doctor?
The following serious symptoms of an epidural steroid injection that require immediate medical attention include:
- Severe headache while sitting or standing and feeling better after lying down, which may indicate an epidural hole.
- A fever of 101 degrees or more, which may indicate an infection.
- Complete decrease or loss of bowel or bladder control while the patient is still sedated or after local anesthesia and temporary numbness has subsided, which may indicate a medical emergency, such as cauda equina syndrome.
- A feeling of numbness and/or weakness in the leg(s), which may indicate a nerve injury.
It is important to contact a doctor immediately if these symptoms occur. Additionally, any discomfort or abnormal feeling should be discussed with your doctor.
Studies on the treatment of disc injections
Spinal disc price in Türkiye
The cost of disc treatment by injection in Turkey is approximately $1,500. Contact Bimaristan Medical Center for medical advice and book an appointment as soon as possible.