I had a thought. Okay, most of us here get those darn injections without any luck of them working. I have done some thinking and I wonder if there are some factors that can make them work better or not.
One, if a disc is degenerating, there really is no way to make it better, right? So, in theory, an injection wouldn't really help anyone with DDD. Now, maybe a nerve block would be good for pain to help the nerves that may be involved.
So, then they would be, in theory, good for bulges. B/c it would take the bulge down in size, in theory again. RIght? Now for a complete herniation, how could a injection help, unless the tear of the herniation heals first?
Okay, here is one thing that is a positive for ESI.
Now, I have had two done on my low back. Your normal one injection into the disc space to make the steroid fill the area and penetrate to decrease the swelling. Both failed (the second time though I had the DDD). NOW, I had a TRANSVERSE injection in my neck. So, instead of the one into the disc space, I had one injection on EACH side of the disc, through the nerve pathway. I can't explain why, but my DR said this would be better than the general one injection. The downfall, if you have one disc, then two injections, two discs three. So, when I had this done if I had gone with all transverse ESIs, I would have been poked SIX times. I was not willing at the time, so I went for three. Two in neck and one in low back.
So, just a thought. I will see if I can find more on the neck one to describe it better. I just wonder, if you have a bulge that the two inj would benefit better than the one (got rid of my pinched nerve!)
technical term: transforaminal ESI. It is like I said, done laterally to deliver meds closer to the nerve root and affected area.
Mod= Can I cut and paste the wording of what I found?(as long as I quote and leave out the web site name?)
Sorry that I wrote the word wrong as transverse, though i think it is similar.
Funny (well not ha ha funny) how you mentioned you were poked or suppose to be poked six time. I just had my medial branch block this past Tuesday and I was poked TEN times! They did five different levels and since I had pain on both sides they did each side...it wasn't fun but afterwards the back pain had completely gone away (so did my legs for I couldn't feel them) It was all the numbing stuff so it wasn't that bad for the surface of the skin but that numbing stuff going through all my nerves and tissues really irritated my back in a different way in that it felt like they were injecting fire into me. It would only burn for the duration of each injection. Nonetheless however, the branch block was successful and I'm waiting on the hospital to see what they're gonna do next. I was just writing about this because you were talking about injections. I agree with what you've written about the ESI's. I am of the same opinion but unfortunately for me, it's all in the doctor's hands. I can't merely request or deny something without going through some huge process. I would think that for a bulge two injections might be better because it's hitting the disk at both angles...
So, then they would be, in theory, good for bulges. B/c it would take the bulge down in size, in theory again. RIght? Now for a complete herniation, how could a injection help, unless the tear of the herniation heals first? (mel)
I am not sure how it would take the bulge down in size. The bulge is disc material and the shot does not have any effect on that, only the surrounding tissue. The Spine Specialist told me, when he told me that I had a slight bulge, that nothing would make it good as new again, a bulge is a bulge. I was so bummed.
I agree with what you've written about the ESI's. I am of the same opinion but unfortunately for me, it's all in the doctor's hands. I can't merely request or deny something without going through some huge process. (aestrella411)
Yes, you can refuse any procedure. My husband did. He was a WC case and he was told that he must follow protocol. He told them, no shots. He then had an EMG and then fusion. The EMG showed nerve damage and two herniated discs. The shot process would have set us back two months. One needs to take a stance.
I was reading and a bulge can be reabsorbed, and have reduction in size. This may or may not be resulting from the injection though. You are right, once a disc bulges it is damaged, but the bulge can be shrunk thus relief from pain, or some anyway. I am sure this is another thing that is DR sensitive, just b/c one says so or not, doesn't mean another will agree.
Not that this is correct but the first surgeon I went to said the purpose of getting an ESI for me was to relieve my pain enough that I could exercise. He said increasing blood flow to my back could make it possible for my body to reabsorb a bulging or ruptured disc. It would also make it possible for me to strengthen my core muscles to take some pressure off of the injured area. He also misdiagnosed me as having a bulge at L4,L5 when my real problems was a huge far lateral rupture at L5,S1 so maybe that tells me all I need to know about his ESI theories.
Because I have a bulge, L3/L4, I would be most interested in finding out how a bulge would reabsorb. I had read Al's post about a jelly donut and knew that was factual information as that is what the doctor told me at one time, but I am confused about the reabsorption part of this post. When the doctor told me that my disc had bulged, I asked if there was anything that could be done about it. He said, "no more twisting at the waist, push, don't pull, and that if I followed an exercise regime, it might not herniate and leak". No alternatives were offered. That would be great news if it just went away. Right now, as far as I know, it is not causing any pain. It showed up on a MRI. My pain is in my Sacro Illiac joint.
If you can steer me to where I might find info to give to my doctor....
Last edited by injured betty; 01-22-2005 at 11:48 AM.
Reason: quoted wrong person
BUT, what he told you were things to prevent further damage-I see no confusion here. Maybe the disc reabsorbs the disc, maybe it doesn't. It makes sense though if you think about it. I think a lot would depend on the severity of the bulge too. Howwould some get better if the bulge didn't shrink? Pressure somehow gets taken off the nerve-hence bed rest and steroids. I didn't see anywhere though where the ESI helped with this reabsorbsion though-so I don't want that to be mistaken. I guess we need to find out if anyone on here ever had a bulge at one time then at another it was either gone or not as big. I can't give you sites to read what I did (rules, right?), and I don't see my dr for two more months.
None of my bulges ever went away-I was just wondering initially if the ESI did that or not, apparently not.
I am a little confused about the whole ESI thing. I had 2 for post ops scar/adhesions on the nerve root. Had herniation at L5/S1. No talk preop about ESI's. I was told the injections would help with nerve inflammation and therefor pain. The injections made things worse. I have read on these boards or on an arachnoiditis site (sorry I can't remeber where) that these compounds that are injected are in fact damaging to nerves because of preservatives and alcohol used in combo with the steroids and are not recommended for the epidural space by the drug manufactureres. I don't know how accurate that is and would appreciate hearing if anyone has more info about that. I have no intention of having any further injections and would change doctors before doing that.
Best to all,
you are right, they are supposed to help eleviate pain. For most of us they don't help. But, it did help my neck bulge, but never for my back (but that was DDD too). Any kind of injection could cause more damage I guess-I wish I could help ya a little more. I am thinking about asking my PM doc for more info and see what he says. WHO knows-I think this is one of those topics that we will never have good answers too. My purpose was only to ask if others felt the two injections may be better than just one.--well, I think so anyway-I meant for that to be the question, but I think I may have gotten off track so I apologize if I did! That really was my intent.
Mod-can we copy and paste from articles as long as we don't say where they came from?