Adverse Effects from Epidural Steroid Injections

Epidural steroid injections have become a mainstay of treating herniated discs (sciatica).  As a interventional pain specialist I’ve seen them work well to avoid surgery hundreds of times. However, there can be adverse effects from epidural steroid injections.  These side effects are generally much less than surgery.  The side effects from epidural steroid injections can be: increased pain or numbness, an increase in epidural fat causing pressure on the nerve, immune and repair function suppression, just to name a few.  In our clinic, we consider that the most concerning of these side effects of epidural spinal shots for pain are caused by the extremely high doses of steroids commonly used.  Steroids are a two edged sword (like cortisone). They do bring down swelling around the nerve.  However, for an unknown reason (likely due to medical tradition and certainly not medical science), most physicians use about a million times more steroid than your body uses on a day to day basis.  We’ve found that lowering the dose of steroids from the milligram range to the nano-gram range doesn’t diminish the anti-inflammatory effect, just the side effects.  This is because your body naturally produces it’s own steroids in nano-grams (one billionth of a gram) and not milligrams (one thousandth of a gram).  We also commonly add in platelet lysate (growth factors isolated from the patients blood and processed in a our cell culture lab).  These growth factors (especially VEGF) can help bring in much needed extra blood supply to the poorly vascularized and nutritionally challenged disc, helping the disc heal itself.  We can also create a VEGF rich supernatant (we call it super VEG) by culturing the patient’s blood platelets.  What if the disc/nerve (sciatica) problem still persists?  We then turn to using the patient’s own stem cells to heal the tears in the disc and get rid of the bulge.  For more information, click the link in the last sentence or check out the video below:

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Fix Back Disks without Surgery

The low back has disks that act as cushions between the back bones.  In order to fix back disks without surgery, the disk has to be repairedin some way.  This is because as we ageor the disks are injured, they can bulge and press on spinal nerves, causing sciatica.  Many things have been tried through the years, including spinal decompression therapy.  This newer form of traction is interesting, but in our clinic we have not seen a significant benefit over traditional traction to justify it’s high price.  Instead of this modality, consider an inversion table, which you can use at home.  Other non-surgical options haven’t existed until recently.  A new procedure injects your own adult stem cells into the low back disks to repair damage.  This can help repair the tears in the disc that caused the disk to bulge (which then presses on the exiting spinal nerves).  This new procedure can be performed through a needle, without the need for surgery or big recovery times.  A video that helps to explain how to fix back disks without surgery can be found at this link.  This video reviews how traditional low surgery removes the bulging part of the disc, which can weaken the disk and lead to more complications such as a re-herniation of the disk.  A case report with an MRI is discussed.

What Causes Back Pain?

As a physician who has seen thousands of patients with back pain, there are many causes.  These include disc problems where the disc is painful or can be damaged causing a bulge or herniation.  Back pain can also be caused by a disc placing pressure on a nerve.  If this is the case, newer stem cell procedures can repair the disc bulge.  Back pain can also be caused by irritated or damaged facet joints.  Yet another cause of back pain is the SI or sacroliliac joint.  Muscles and ligaments being overloaded or injured can also lead to significant back pain.  Back pain can also be due to occult problems like vertebral compression fractures, cancer, a balooning out of the aorta, etc…  

The most important part of a back pain work-up is identifying a specific strutcure that is causing the pain.  Just throwing narcotics or other medications at the problem is extremely counter-productive.  Too often back surgery is the conclusion when the cause of back pain goes undiagnosed.  This can cause significant complications.