EPIDURAL INFILTRATIONS

Epidural or peridural infiltration is a procedure in which a pain-relieving medication is injected near the nerve roots in the spinal column.  Most patients who undergo peridural treatment suffer from neuropathic pain, as in the case of pain caused by herniated discs.

Epidural therapy is often the first interventional treatment in herniated disc radiculopathies; in fact, peridural antalgic therapy is considered the gold standard in the conservative treatment of lumbosciatica. The aim of peridural treatment is to inject the inflamed nerve root from which the pain originates with a mixture of steroid and anaesthetic, which respectively have anti-inflammatory and analgesic activity.

We generally differentiate between three types of peridural therapy:

The antalgic peridural infiltration is indicated in patients with cervical or lumbar radiculopathy caused by a herniated disc. Once the affected intervertebral space has been identified, the needle (Tuohy‘s needle) is positioned and a solution of cortisone and local anaesthetic is injected into the peridural space. The peculiarity of this method is that by passing inside the spinal column, the medication can be placed more precisely between the hernia and the root.

The insertion of the needle into the intervertebral foramen, under fluoroscopic guidance, allows the root affected by the pathological process to be reached. The target of the procedure is confirmed by the use of contrast fluid. Infiltration of the root with anti-inflammatory drugs, such as slow-release cortisone or ozone, allows the pain to be resolved.

The caudal epidural injection is an injection in the lowest part of the epidural area, which allows through the insertion of a needle from the sacral hiatus the upward diffusion of the injected substance into the epidural space (local anaesthetic and glucocorticoids). The caudal epidural injection is often preferred in the treatment of lumbosciatica because it is easier and safer than the lumbar epidural.

CASE STUDY EPIDURAL

Roberta, a young 25-year-old athlete, has been suffering from persistent left lumbosciatica for about three months. Roberta has already been treated with physiotherapy sessions, analgesic and anti-inflammatory drugs with little benefit. Despite the treatments Roberta continued to experience back pain, burning and tingling in her left leg, so she decided to consult Dr Lo Bianco. Carefully evaluating the electromyographic examination of the lower limbs and the magnetic resonance imaging of the lumbar spine, together with a thorough specialist examination, Dr. Lo Bianco identified the cause of the problem in a herniated protrusion at the L3/L4 level. Dr Lo Bianco then suggested a program of selective antalgic and foraminal epidural infiltration of the affected root (left L3/L4). The procedure, on an outpatient basis, allows the root affected by the pathological process to be reached. The infiltration of the root with anti-inflammatory drugs, such as slow-release cortisone, allows the resolution of the pain.

“I never thought I would suffer such pain at my age. I could no longer walk, let alone exercise. Doctor Lo Bianco allowed me to return to a normal life, he was very kind to me, I felt no pain during the operation. I am happy to have turned to him and to have definitively solved my problem.” Roberta

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