Discectomy, Epidural Steroid Injections, L4-L5 herniation

SLIPPED DISC AT L4-L5, SYMPTOMS AND TREATMENT

COMMON SYMPTOMS AND SIGNS OF L4-L5 SLIPPED DISC

Depending on the type and severity of the underlying cause, the L4-L5 slipped disc may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica. Common symptoms and signs include:

  • Sharp pain, typically felt as a shooting and/or burning feeling that originates in the lower back and travels down the leg in the distribution of a specific nerve, sometimes affecting the foot.
  • Numbness in different parts of the thigh, leg, foot, and/or toes.
  • Weakness while moving the thigh, knee, or foot in different directions.
  • Abnormal sensations, such as a feeling of pins-and-needles and/or tingling.

TREATMENT FOR L4-L5

Nonsurgical Treatments for L4-L5

  • Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, and/or corticosteroids may be used.
  • Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilise the back and keep the muscles and joints well-conditioned—providing long-term relief.
  • Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5.
  • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
    • Repeated bending of the spine
    • Sudden, abrupt movements, such as jumping
    • High-intensity exercise and lifting heavy weights

Injection Treatments for L4-L5

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibres to pain, generating fewer pain signals.
  • Radio-frequency ablation. Radio-frequency ablation may be used to treat pain from the L4-L5 vertebral facet joints.

Surgical Treatments for L4-L5

  • Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the facet joints.
  • Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
  • Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability. https://www.nhs.uk/conditions/slipped-disc/
Epidural Steroid Injections

EPIDURAL STEROIDS INJECTION ( herein after referred to as ESIs) FOR LOWER BACK PAIN & SCIATICA

ESIs are sometimes used to treat many forms of lower back pain and sciatica. The goal of injection is pain relief. If the initial injection is effective, the patient may have up to three injections in one-year period. ESIs are sometimes used to ease pain experienced in the cervical region (neck) and thoracic region (mid spine).https://www.nhs.uk/conditions/epidural/

The following conditions can cause acute or chronic lower back pain and/or sciatica and can be treated by ESIs:

  • Herniated disc – where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves.
  • Lumbar spinal stenosis – a narrowing of he spinal canal.
  • Degenerative disc disease – where the collapse of the disc space may impinge on nerves in the lower back.
  • Compression fractures in the vertebra – where vertebral bone in the spine has decreased at least 15 to 20% in the height due to fracture.
  •  Cysts – which are in the facet joint or the nerve root and can expand to squeeze spine structures.
  • Annular tear – where a tear is present in the outer layer of the disc.

ESIs should not be performed on patients whose pain could be related to a spinal tumor. If spinal tumor is suspected, an MRI scan should be done prior to the injection to rule out a tumour. ESIs should also not be performed on patients with local or systematic infection and patients with bleeding problems (hemophilia patients).https://www.evidence.nhs.uk/search?q=epidural+steroid+injection

Epidural Steroid Injections

POTENTIAL SIDE EFFECTS & POSSIBLE SIDE EFFECTS OF EPIDURAL STEROIDS INJECTIONS.

POTENTIAL SIDE EFFECTS:

  • Bleeding. Bleeding is more common for patients with underlying bleeding disorder.
  • Dural puncture (‘wet tap’). Epidural steroid injections may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days.
  • Infection. Infection is usually caused by foreign body (injection) penetrating the skin.
  • Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the needle or from infection or bleeding.

POSSIBLE SIDE EFFECTS:

  • localised increase in pain
  • non-positional headaches resolving within 24 hours
  •  facial flushing
  •  anxiety
  •  sleeplessness
  •  fever, mostly the night of injection
  •  high blood sugar
  •  stomach ulcers
  •  cataracts
  • severe arthritis of the hips (avascular necrosis)https://www.nhs.uk/conditions/epidural/side-effects/
Epidural Steroid Injections

EPIDURAL STEROID INJECTIONS

Some people who suffer from back pain are given epidural steroid injections to try help relieve their back pain. A person receiving these injections is only given few a year, usually 2 and in most cases not more than 3 injections a year. Do you know the reason why they are given few injection?

… its because there’s a chance that these drugs might weaken your spinal bones and nearby muscles. This is not caused by the needle, its a possible side effect of steroids.

Epidural steroid injections contain drugs that mimic the effect of the hormones cortisone and hydrocortisone. When injected near irritated nerves in your spine, these drugs may temporarily reduce inflammation and help relive pain.

Steroid injections also disrupt your body’s natural hormone balance. Delaying repeat injections allows your body to return to its normal balance. This is the reason why these injections are not give too frequently.