Lumbar steroid injections question

[cp7959]

If you have sciatica down one leg and the pain overlaps the typical L5/S1 and L4/L5 pattern, how does a doctor determine which level to inject steroid?

[cherylstewart67]

I had injections and I actually made it on a plane for 8 hours afterwards. If its an SI joint like mine they did not do any testing. If its a posible disc issue, they made do a discogram.

[Maria]

Generally the person/patient has already had an MRI or some recent diagnostic test that would show levels with problems. Before you get an ESI inquire if you're having it done with fluroscopy because if not then you don't want to have it done as it's probably more or less a blind stick. Fluroscopy is a way to guide insertion and direct the needle placement and adminstration of steroidal material accurately to most involved (or what appears to be) level(s). There are a few different types of approaches.. transforaminally worked best for me tho have had a caudal approach as well depending on level administered to.

[cp7959]

Thanks for the responses. The issue is one that an MRI does not give a clear picture.

My MRI notes:

L5/S1 disk desiccated, slight loss of disk space. Posterior and to the right annular tear but no disk protrusion, neural foramina patent.

L3/L4 Broad Based central protrusion (4mm) which mildly effaces the thecal sac, neural foramina patent.

All other levels are fine.

This MRI could be anyone, with no problems. I have left sciatica which at times feels like L5/S1 and other times like L4/L5. I have no back pain, which is usually the primary symtom for DDD. However with a herniation it is likely to have sciatica with no back pain.

Othropedic surgeon feels it could be from the central protrusion at L3/L4 effecting the nerve roots going to my left side in the spinal canal. Injection shoud be given at L4/L5.

Pain DR. feels L5/S1 tear is the problem. Althought the tear is to the right the leak disc could be working it's way to the left.

I can't imagine a discogram to indicate where to give a steroid injection.

So I'm not sure what I should push for. Any opinions are appreciated.

[Maria]

who's performing the ESI? Is it the PM? Is it the Ortho? The caudal approach will bathe the general area probably from L5S1 up I believe and then if you're going to get a series of 3 injections they can see if doing one level say L5S1 helps and if not maybe the next time L4...

It could be the anular tear that's giving you the probs or the broad based disc bulge or both.

A discogram seems to help depict the most painful level re disc problems. Have you had one done? I have 3 and all pointed to L5S1 being my worst level so we went with ESIs at that level for a number of years and then later it seemed I autofused at that level and L4 was worst so then transforaminal approach was used at that level (based on MRI) and that helped significantly.

I also had L3 done as I have an anular teat at that level tho no help whatsoever so it was determined that wasn't a level that needed ESIs and for 10 years that was accurate apparently (got them for 10 years and they helped my symptoms significantly).

[jsewell]

I have had my share of back pain and ESI's and most recently a severe bout of sciatica. so severe i was confined to a wheelchair for mobility.

For the ESI's before i had any lumbar surgery , i always had my ortho spine surgeon perform these. He did several levels at one time so i never had any decisions regarding this to make. They were always for back pain and sometimes did not work at all and one time worked for almost a year.
On August 2nd i had lumbar surgery including a fusion of L4-5 (the rest above are fused) and woke up with the severe sciatica pain. I could not even put my toes down on one leg or straighten my leg and was in constant pain . I waited at home, in bed most of the time, until my surgery last Monday (Sept 10th). In between i had epidurals for the sciatica which only improved it about 5%.
Fortunately for me the problem was fixed at this weeks surgery and the sciatica pain is gone. I can walk again. All is good.

I would inquire if a spine surgeon could do all 3 levels or 2 in question at the same time or maybe a week apart to see which is really the problem. I also had a discogram for the thoracic region and it did clearly show which disk was the problem. But not a pleasant procedure.

judy

[jeff]

probably inject all the areas