The lumbar (low back) intervertebral discs are an integral part of your dynamic spine. Discs work in conjunction with the vertebral bodies to absorb and distribute much of the stress and weight changes associated with rest and movement.
The discs are composed of an outer layer or annular fibrosis; a tough substance that retains the inner disc cushioning material, the nucleus pulposus. The nucleus is avascular and does not contain nerves. When compromised, the tough outer layer of the disc can bulge or herniated. This means either the outer layer pushes outward (bulge) or the soft inner layer leaks out (herniated).
Posterior (rear) herniation is common and can irritate or impinge nerve roots and cause back pain and sciatica. Sciatica is a symptom meaning pain felt in one or both legs.
Sciatica pain can be severe and debilitating. A first line of treatment is over-the-counter and non-interventional low back treatments. While pain can be severe, the natural course for disc herniation is for the bulge or herniation to be resorbed – or pull back into a more normal position between the upper and lower vertebral bodies. Usually, pain improves over weeks to months. Alternatively, pain may persist.
Lumbar epidural injections help relieve pain caused by a herniated disc. Pain may travel (radiate) into the legs.
A herniated disc can occur in the cervical (neck) spine and cause neck pain to radiate into the shoulders and arms. Similar to the treatment of a lumbar disc herniation, a cervical epidural injection may be performed to relieve pain.
An epidural injection is performed using fluoroscopic guidance – a fluoroscopy unit is similar to real-time x-ray. Using fluoroscopy a very small needle (25 gauge) is guided to the irritated nerve root and as close to the disc herniation as possible.
The needle enters the epidural space and a very small amount of local anesthetic and steroid is injected. Because the needle is precisely placed within the irritated area, only a small amount of medication is needed. Most patients achieve good pain relief (minutes to days) after a procedure.
If you are interested in an evaluation into the cause of your low back pain and sciatica, or a have questions about how to manage your pain, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, New York and Staten Island, New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.