Non-surgical Treatment of Lumbar Disc Herniation with Pinpoint Shot

Non-surgical Treatment of Lumbar Disc Herniation with Pinpoint Shot

Pinpoint therapy is a procedure that uses epidural steroid injections (ESIs) to help manage the inflammation and pain caused by the herniated disc, targeting the affected area directly.

A herniated disc (lumbar disc herniation) often comes with persistent pain that can disrupt your daily routine. It’s important to know that you’re not alone as you navigate this journey, and that there are effective treatment options available to manage your discomfort. One of these options is epidural steroid injections, a procedure that delivers anesthesia directly to your spinal nerves, providing significant relief at the source of your pain.

What is the cause of a herniated disc?

One of the most common reasons why patients seek epidural steroid injections is a herniated disc. This occurs when the soft inner part of the disc pushes through a crack in the hard outer layer. This protrusion can irritate nearby nerves, causing pain, numbness, or weakness in the arm or leg.

The symptoms of a herniated disc can vary depending on the location of the herniated disc and whether it is pressing on a nerve.

The main symptoms of a herniated disc include:

  • Pain in your arm or leg
  • Numbness or tingling near the affected nerves
  • Weakness in the muscles near the affected nerves

Herniated discs are also often caused by age-related wear and tear, known as disc degeneration. As we age, the spinal discs lose some of their fluid content, making them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Sometimes, lifting a heavy object or turning suddenly can also cause a herniated disc if you are not using your leg and thigh muscles properly during the action.

A pinpoint epidural injection for a herniated disc can play an important role in managing the pain associated with the condition. ESIs can deliver anti-inflammatory medication directly to the source of your pain, reducing inflammation around the irritated nerve, relieving pressure, and easing your discomfort.

How does epidural injection affect a herniated disc?

In this procedure, a corticosteroid, an anti-inflammatory medication, is injected into the epidural space in your spine. The epidural space is the area between the dura mater and the vertebral wall, which contains fat and small blood vessels. The procedure is called an “epidural” because it is located outside the dural membrane. When a corticosteroid is injected, inflammation and swelling are reduced, which relieves pressure on the nerves and other structures in your spine. This can significantly reduce or even eliminate your pain.

Anesthetics play an important role in epidural steroid injections. In addition to the corticosteroid, a local anesthetic such as lidocaine or bupivacaine is usually included in the injection. This serves two purposes:

  • It helps provide immediate pain relief.
  • The cortisone helps confirm that the injection was administered in the correct place.

If your pain subsides shortly after the injection, it is a good sign that the medication is reaching its intended target.

Remember, although epidural steroid injections can provide significant relief, they are usually part of a comprehensive treatment plan and help control your pain while physical therapy or other treatments are administered that aim to address the underlying cause of your discomfort.

What are the benefits of epidural steroid injection?

Epidural steroid injections don’t just relieve pain. They can also reduce inflammation and swelling around the spinal nerves, improve mobility, and allow you to participate more actively in physical therapy and other rehabilitation exercises. This can increase your strength and flexibility, which can promote a faster and more complete recovery.

Moreover, by controlling your pain, ESEs can reduce your need for oral painkillers, which often have side effects such as drowsiness or upset stomach. This means you can enjoy a better quality of life, free from both pain and the unpleasant side effects of medications.

In which areas are epidural steroid injections applied?

ESEs can be administered at different locations along your spine, depending on the source of your discomfort:

Cervical: The cervical region targets the neck area. Injections here can help manage conditions such as cervical disc herniation, cervical radiculopathy, and neck pain.

Thoracic: The thoracic region refers to your mid-back. Thoracic injections are administered to manage mid-back pain, thoracic disc herniation, and radiculopathy.

Lumbar: The lumbar region is your lower back. Injections in this area are used to treat conditions such as lumbar disc herniation, sciatica, and lower back pain.

What are the types of injections for a herniated disc?

There are three types of spinal injections for herniated discs: caudal, interlaminar, and transforaminal.

Caudal Epidural Steroid Injections: Caudal ESE is a common type of spinal injection. The procedure involves injecting a corticosteroid into the lowest part of the epidural space, which is accessed through the sacral hiatus, a small opening just above the tailbone. This method allows a large amount of medication to be injected into a large area of ​​inflammation. If you have pain in more than one area of ​​your lower back or legs, caudal ESE may be an effective treatment option.

Interlaminar Epidural Steroid Injections: Interlaminar ESE is performed by injecting medication directly into the epidural space between two vertebrae. This type of cortisone injection is commonly used for herniated discs because it allows the medication to spread to more than one spinal level and potentially treat more than one nerve root. It can be performed at any level of the spine, cervical, thoracic or lumbar, depending on where your pain is located.

Transforaminal Epidural Steroid Injections (Pin Shot):Transforaminal ESEs, also known as pinpoint shots, are targeted injections. The medication is injected near the nerve root that is believed to be causing your pain. This method allows for precise delivery of the steroid by focusing on the specific area where inflammation is occurring. If your pain is localized to a specific area, transforaminal ESE may be an effective approach.

How is pinpoint injection different from other epidural steroid injections?

Pinpoint (transforaminal epidural steroid injection) involves injecting pain-relieving corticosteroid medications directly into your epidural space (the space between your spine and spinal cord) in a targeted manner.

Unlike other epidural steroid injection techniques, the transforaminal approach requires X-ray guidance (fluoroscopy) because of its greater precision. X-ray images make it easier for doctors to find and target specific spinal nerves.

What should you pay attention to before the procedure?

Before the pinpoint application:

  • If you are pregnant or may be pregnant, you should inform your doctor of any medications you are taking, including herbs, supplements, and other medications you take without a prescription.
  • You may need to temporarily stop taking blood thinners?

How many doses of pinpoint shots are applied?

Your doctor will determine the frequency of injections based on your general health and condition. Getting these injections too often can weaken the bones of your spine or nearby muscles. Higher doses of the steroids in the injections can also cause these problems. For this reason, you are usually limited to three injections per year.

Your doctor will order an X-ray, MRI, or CT scan of your back before the procedure. This will help your doctor determine the area to be treated and the dosage.

In the case of a new hernia, the injections may be given several weeks apart (closely spaced) to allow for rapid and complete resolution of symptoms. For chronic conditions, injections are usually spaced 3 to 6 months or longer between injections.

Are there any risks to pinpoint shooting?

Although ESE procedures are generally safe, complications such as:

  • Mild dizziness, headache or nausea
  • Nerve root damage with increasing pain in your leg
  • Infection in or around your spine (meningitis or abscess)
  • Allergic reaction to the medication used
  • Bleeding around the spine (hematoma)
  • Possible rare brain and nervous system problems
  • Difficulty breathing if the injection is in your neck

How is the recovery after the application?

The recovery process after a pinpoint injection is usually straightforward. Immediately after the procedure, you may feel some numbness in your legs due to the local anesthesia. This feeling is temporary and should subside within a few hours.

You may feel pain at the injection site for the first few days. This is a normal part of the healing process and should not cause unnecessary concern. Applying an ice pack to the area can help manage discomfort.

It is very important to take care of yourself after the injection procedure to maximize the benefits. While rest is important, light activity is also recommended. Light walking or stretching can help keep your muscles flexible without straining your spine. You should avoid heavy movements.

When will results be seen?

Everyone experiences pain relief after an injection differently. Some people report immediate pain relief after the procedure thanks to the local anesthetic used. However, the effects of the anesthetic are temporary and some of your existing pain may return after a few hours.

Corticosteroids, which reduce inflammation and provide long-term pain relief, usually start working within 1 to 3 days after the procedure. However, it may take up to a week for you to feel the full benefits.

Remember, recovery is usually gradual and may require multiple injections. As you progress through your treatment, your doctor will provide guidance and adjust your treatment plan as needed to ensure that you are progressing toward your goal of pain relief.

How long does the effect of pinpoint treatment last?

Pinpoint injections can help provide lasting pain relief for patients with a new hernia. For patients with chronic pain or recurring hernias, the desired duration of effect is three to six months or longer.

Are pinpoint injections painful?

There is no severe pain during the procedure because the area where the epidural needle will be placed is numbed by injecting local anesthetic into the skin.

Should epidural injections be supported by physical therapy?

In the treatment of herniated discs, the combination of steroid injections and physical therapy is considered an effective approach to alleviate symptoms. Steroid injections reduce inflammation and relieve pain, while physical therapy increases muscle strength, improves flexibility and supports spinal stability. This combination can help patients return to their daily activities more quickly.

In a study, both epidural steroid and physical therapy groups showed significant improvements in pain and functional parameters.

References

  • Cleveland Clinic
  • US National Institutes of Health (NIH)
  • Mayo Clinic
  • Spine DOI: 10.1097/BRS.0b013e31819c0a6b
  • Interdisciplinary Neurosurgery DOI: 10.1016/j.inat.2020.100706
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