ROLE OF EPIDURAL INJECTIONS IN THE MANAGEMENT OF ACUTE LUMBAR DISCOGENIC PAIN

Abstract

INTRODUCTION: The use of epidural injections in the cervical, thoracic and lumbo sacral spine for both diagnostic and therapeutic purposes has developed as an important part of a comprehensive interdisciplinary approach to spinal pain.((1,2)) It is well known that structural abnormalities seen on CT or MRI scans do not always cause pain and diagnostic injections often can help correlate abnormalities on imaging studies with associated pain complaints. Therapeutically, epidural injections can provide significant pain relief during which, time recovery of disc and nerve root injuries can occur and patients also can progress their level of physical activity. In acute disc injury with or without radiculopathy, therapeutic injections can help and manage the patient's pain without reliance on oral analgesics. Epidural cortico steroid injections with physical therapy is recommended in conjunction.((1)) Mechanism of pain relief is due to potent and anti-inflammatory properties of the cortico steroids.((3,2)) Aim to know the efficacy and results of the epidural steroid injection in acute lumbar discogenic pain.((2)) MATERIALS AND METHODS: I have treated 800 patients with lumbar epidural injections for 3 weeks (Weekly interval) since 2005 at Sri Venkata Hospital and pain management centre SP Nagar, Kukatpally, Hyderabad, Telangana. For the management of Lumbar Discogenic Pain till 2014. RESULTS: Excellent in 90% of patients and no patient complained of recurrence of symptoms and reached their normal activities without surgery after epidural injection treatment. Lumbar Epidural steroid injection is usually performed in about 6 weeks after the onset of low back pain or radicular pain. Lumbar Epidural steroid injection is appropriate for an outpatient setting provided all necessary resuscitative equipment is available i.e. O-2, intubation equipment, emergency drugs, IV access and we can avoid the hospitalization. DISCUSSION: LESIs((3,4,5,6)) appropriate for O.P. setting provided all necessary resuscitative equipment available i.e. Oxygen, intubation equipment, emergency drugs, IV access, monitoring Pulse, B.P. for every 15 min. observing for 45 min. follow up phone call after 24 hrs. CONCLUSION: Initial epidurals are very effective in the management of acute Lumbar Discogenic Pain and may not require surgery just by MRI findings.