Author: Flying Chimp

One of the most common injections I perform is in the lumbar spine. It’s called a transforaminal epidural steroid injection. That’s a long phrase just to describe a injection of steroid, not in the spinal canal, but next to the spinal canal, where the nerves exit that can be tailored very specifically to the pinched nerve in question.

The steroid medication can then trickle into the spinal canal, in ideal cases provide long-term lasting relief. It’s not uncommon to need more than one to get patients back to their optimal state. And frankly, it’s typically a good thing to try and, and select patients with lumbar problems before considering surgical intervention.

Vertebroplasty is an older procedure that predates kyphoplasty literature on it. Today, really questions its effectiveness as an intervention, and it involves putting a needle into a broken bone and through that needle, pumping liquid cement into that broken vertebrae and fixing the fracture in place.

Its results, at this time are considered questionable.

Kyphoplasty is procedure that’s been out now over 20 years. It involves treatment for fractures in the lower, mid back or low back that are unresponsive to non-surgical treatment. A needle is placed in the broken bone and through the needle. A balloon is passed. The balloon is inflated, and surgical cement is put into the fracture instantly fixing it.

For a while we thought that pretty much everybody with a fracture in these areas needed a kyphoplasty and as quick as a fashion possible. Now we know that it’s been out for a long enough time, has been studied that it’s not a procedure that should be done in everybody, but rather, certain cases that take longer to heal or, or patients with a fracture that collapses worse.

Spondylolisthesis just means slippage, and that’s where in the spine one bone is slipped on the other one vertebrae. So on one end it may just be something we see on X-ray that’s not really causing any problems. On the other end, if it’s very unstable, moving a lot, it could be something that requires timely surgical intervention.

Spinal fusion in the lumbar spine has been around for a long time. Frankly, for a while it was overperformed and still in some cases is overperformed. The surgeon has to be very selective about who he performs or she performs a lumbar fusion on, as the outcomes can vary greatly, in certain cases, there’s no choice, such as when the spine is unstable and the patient’s at risk for severe neurologic injury unless the spine becomes stabilized or in cases of fracture or stress fracture.

In other cases, often a less invasive procedure performed on an outpatient basis could be attempted first, and with that minimum intervention, you get the patient good enough where they don’t need the more aggressive fusion.