Symptoms

The development of complaints depends on two things:

The extent of the pressure damage: The stronger the pressure on the nerve structures, the greater the discomfort.
The speed of the pressure damage: The faster the pressure on the nerve structures develops, the greater the complaints. In the assessment of imaging procedures (e.g. MRI), in relation to the complaints presented, this can mean, conversely, that comparatively very tight spaces for the nerve structures can cause little discomfort if they have developed slowly enough. The nerve structures had the opportunity to adapt to the new space conditions. If the extent of the possible adaptation is exceeded, decompensation of the clinical picture occurs. The symptoms will then become accentuated (significantly worse).
Local back pain
Pain radiating into the arms or legs (CervicobrachialgiaLumboischialgia)
Reflex failures
Sensory disorders of the skin
Loss of strength of the musculature paralysis (pareses) e.g. loss of maximum walking performance, tired legs, insecurity when walking, weakness of the foot lifter and foot sinker

Access ways

There are two types of access routes for infiltration, depending on the level of inflammatory processes to be treated: epidural infiltration and sacral infiltration. The epidural infiltration is used for affected areas of the upper lumbar spine and the sacral access route is more commonly used for affected areas of the lower lumbar spine and sacral nerves. The two access routes differ mainly in the position of the needle, but the therapeutic effects and drugs used remain the same.

In the case of sacral infiltration, access is at the lower end of the sacrum. The spinal canal continues into the sacrum, but since the sacrum has no spaces like the mobile spine, the needle must be inserted into the spinal canal from the lower end of the sacrum. In epidural infiltration, the needle is positioned between the spinous processes of the lumbar spine and then advanced into the spinal canal, the so-called epidural space.This access route can also be used on the cervical spine, but must be checked by x-rays at this height.

As with spinal cord anaesthesia, a height for infiltration from the back is determined for epidural infiltration. This is based on the height of the pathological changes present, for example, whether a narrow spinal canal has the main findings in the area of the 2nd lumbar vertebral body or whether it is lower or higher. Infiltration of the lumbar spine is usually performed on a sitting patient who is bent forward.

After skin disinfection, the height of the access point is determined by palpation and the infiltration needle is advanced into the spinal canal up to the hard skin of the spinal cord (dura). After piercing the ligament of the vertebral arch (Ligamentum flavum), there is a sudden drop in the pressure of the syringe, which indicates to the doctor that the spinal canal has been reached. If the spinal cord skin is injured, nerve fluid flows back out of the needle (cannula) and the needle must be retracted again a little (this would correspond to the needle positioning during spinal cord anaesthesia).

The resulting hole in the hard skin of the spinal cord closes again by itself. The patient usually does not have to fear complications. There is also no risk of injury to the spinal cord nerve fibers, because they can float in the neural fluid from a certain area of the lumbar spine and avoid the needle without any problems.

In contrast to sacral infiltration, the access route of epidural infiltration is variable. Thus, even higher-lying spinal column changes with nerve root irritation can be treated. Epidural infiltration is also suitable for herniated discs of the cervical spine or for a painful spinal canal narrowing of the cervical spine.

In contrast to therapy in the lumbar spine, needle position control via a mobile X-ray unit (X-ray image converter) is necessary. A long needle is used to visit the spinal canal space under X-ray control and a mixture of saline solution and cortisone is injected directly in front of the spinal cord at the height of the herniated disc. Epidural means that the drug is injected before (epi) the hard skin of the spinal cord (dura), so that the skin is not injured and the spinal cord is not in danger of being injured.

Since the spinal cord and its skin cannot be seen on an X-ray, a small amount of an X-ray contrast medium is injected before the drug is administered. Based on the distribution of the contrast medium, it is easy to check the position of the needle tip, so the procedure is not very dangerous. Due to the distribution and irrigation of the spinal cord and its outgoing nerve roots, this infiltration usually reaches several nerve roots simultaneously.

The pain therapeutic effect is very good. The infiltration can be repeated several times. Anesthesia is not necessary.

The procedure is also not particularly painful. The aim of epidural infiltration in the lumbar spine is to inject a drug directly into the epidural space in the spinal canal. This plays a decisive role in the therapy of chronic back pain or in preparation for surgery.

In the case of epidural infiltration in the lumbar spine, the anesthesia is mainly effective in the lower extremities and the lower lumbar region. Another area of application is obstetrics. Shortly before birth, an injection is placed in the spinal canal to minimize pain during the birth process.

In case of complications, a caesarean section can also be performed without problems. At the beginning of the procedure, the patient is prepared by disinfecting the affected region of the back and local anesthesia. This preparation prevents infection and reduces the pain when inserting the needle.

The epidural infiltration is usually performed while sitting or lying on the side. The needle is inserted between the spinous processes of two adjacent vertebrae. To check whether the physician has reached the epidural space, a so-called “loss of resistance” technique is available.

Here the physician uses a small syringe filled with liquid. Before the needle can reach the epidural space, it must first pierce the skin and a ligamentous apparatus. While the syringe is in this solid terrain, the physician must apply a certain amount of force to inject the fluid from the syringe against the resistance of the tissue.

Only when the needle is in the epidural space does this work without much effort. With this method, the physician can check whether the injection has been placed correctly even without parallel imaging.When the needle is finally in position, the anesthetic is injected. This is now located in the gap between the hard meninges (dura mater) and the periosteum of the vertebral body and can thus exert its effect at the exit points of the spinal nerves.

This includes freedom from pain in the affected segment, as well as limited mobility and insensitivity. Overall, epidural infiltration of the lumbar spine without complications takes only a few minutes. It has now become a proven means of effectively preventing pain, whether shortly before painful surgery or for pain therapy.

Sacral blockages or sacral infiltrations are suitable for the treatment of nerve irritations, especially in the lower lumbar spine sections. A mixture of local anesthetic and cortisone is injected into the spinal canal via the sacral canal (sacrum canal) with the help of a cortisone syringe. The access is located in the course of the sacrum above the arch-shaped transition to the coccyx.

Imaging (X-ray) is not absolutely necessary for sacral infiltration. One orients oneself by the anatomical landmarks. Under sterile conditions, 20 ml of a mixture of a local anesthetic and cortisone are then injected into the spinal canal.

There, the fluid distributes itself and washes around the spinal cord and several nerve roots of the lower lumbar spine (lumbar spine) simultaneously. Sacral infiltration is particularly suitable for the treatment of: with corresponding nerve root irritation or spinal canal stenosis in this area, where several nerve roots may be involved in the disease process simultaneously. Higher nerve roots are no longer reached in therapeutically effective doses due to the access route of drug application or very high drug volumes must be infiltrated (30/40 ml).

Depending on the local anesthetic used (local anesthetic), the patient is then asked to lie down for some time (1-2 hours), as the local anesthetic can sometimes cause numbness and weakness in the legs, which can lead to a risk of falling. There is also the possibility of spontaneous water loss (incontinence). The patient must be made aware of this in advance of the therapy.

After the anaesthetic has worn off, these effects disappear again. The pain therapeutic effect is good and, due to the applied cortisone, also persistent. Sometimes a temporary increase in pain can occur due to the increase in volume and pressure in the spinal canal.

A harmless side effect of cortisone can be a reddening of the face (see flush syndrome), which disappears after a few days. The sacral infiltration can be repeated several times. It can also be performed in the practice if the local anesthetic is completely dispensed with or a very low dosage is chosen.

A slipped disc L4/5
A herniated disc L5/S1 and
Disc protrusions of the lowest two intervertebral discs