Peridural Injection for Disc Problems

Peridural injection (PDI) is a conservative therapeutic measure for the treatment of pain syndromes of the spine, especially of the intervertebral discs. The injected substance is a corticoid (for example, triamcinolone, which is an active substance that has an anti-inflammatory and anti-growth effect and suppresses the body’s own defenses; it belongs to the group of glucocorticoids). Scientific studies show that peridural injection is an effective method for rapid pain reduction for the indications listed below (see below). After performing the injection, 68% of patients noted an improvement in symptoms or were pain-free. For acute pain, peridural injection is sometimes superior to other conservative methods.

Indications (areas of application)

Strict indications (with confirmed efficacy in high-quality studies).

  • Disc prolapse or stenosis – In cases of disc prolapse (herniation) with narrowing (stenosis) of the spinal canal or protrusion (prolapse) of the disc into the spinal canal, peridural injection of corticosteroids is a therapeutic option. To reduce further stress on the intervertebral discs in the course, in addition to pain relief, incorrect posture, overloading and weakness of the trunk muscles should be corrected by training methods and training.
  • Lumboischialgia – Lumboischialgia represents a special form of narrowing of the spinal canal. Due to the compression of a lumbar nerve root, the pain is caused. Cause is the compression of the nerve root by a bulging disc in the presence of degeneration (“wear”) of the intervertebral discs.

Extended indications (with not fully secured or not clear indication).

  • Pseudoradicular pain – pain that can be subjectively attributed to intervertebral disc changes, but in the diagnosis is found to be non-radicular (not caused by nerve compression), can be treated by an injection of corticosteroids, if necessary, in combination with a local anesthetic (agent for local anesthesia). However, the effectiveness of the method is sometimes questioned.

Contraindications

  • Bleeding tendency – 90% of all patients with bleeding tendency have an acquired (not congenital) form, most commonly caused by anticoagulants (anticoagulant medications) such as Marcumar.
  • Tumor disease – In malignant tumors, performance of the procedure is usually not indicated. However, in individual cases, peridural injection is possible.
  • Bacterial or viral inflammatory processes in the area of the spinal canal – in the case of inflammation in the area of the spinal canal, an injection must be refrained from.
  • Bacterial inflammation in the puncture area of the injection – due to the risk of carryover of germs into the spinal canal with far-reaching consequences, bacterial inflammation is a contraindication.

Before therapy

Before performing the peridural injection, a medical history and a detailed physical examination must be performed to at least partially name and treat the cause of the pain. The patient should be fasting for the injection. Blood coagulation values should be checked before treatment. Furthermore, possible contraindications must be excluded.

The procedure

The basic principle of peridural injection is based on the action of corticosteroid. The amount of corticosteroid used can vary – for example, a common injection amount would be 20 mg of triamcinolone per injection. Peridural injections are usually performed with the patient seated and under sterile conditions to prevent complications. After infiltrating the skin and underlying tissues in the area of the affected segment with a local anesthetic, the needle is advanced between the spinous processes of the vertebral bodies of the segment through the lig. flavum (“yellow ligament”) into the peridural space (a cleft space located between the stratum periostale (periosteum) and the stratum meningeale (the dura mater/part of the hard meninges) in the area of the spinal canal). After ensuring successful puncture of the peridural space, the corticosteroid is injected.

After therapy

Following treatment, patients should lie flat for at least one hour.Monitoring should be provided during this period.

Possible complications

The most common complication of performing peridural injection is headache, which usually resolves within an hour after therapy is performed and can be considered harmless. Serious complications such as spinal cord injury with paresis (signs of paralysis) are very unlikely. Complications such as bleeding can usually be avoided by observing the contraindications.