A trigger point is a very tender area, usually near the insertion of a muscle or ligament or near a joint, and usually relatively small or well-localized. When trigger point pain is severe and non-responsive to conservative measures, injection with local anesthetic, with or without added steroid, may be helpful. Trigger points may be injected with tiny needles of variable length placed through the skin and into the substance of the muscle. One to five trigger points may be injected in one session, and sessions are typically repeated at regular intervals in a series. Injections that relieve pain allow greater participation by the patient in stretching programs, aerobic exercise programs, and other physical therapy treatments.
The primary indication for an epidural steroid injection is the relief of pain due to inflammation of the nerve elements in the epidural spaces of the spine. The purpose of using an injection is to place the medication as close to the pathologic process as possible in order to gain the best therapeutic benefit. The treatment is used to achieve a significant reduction in pain without the need for surgery. More than a single injection may be required in any given patient
Spine injection procedures have been employed in the management of patients with cervical, lumbar, and radicular pain syndromes for almost a century.
Three routes may be used in the lumbosacral spine:
The translaminar injection offers a potential advantage of delivering solutions directly into the epidural space and therefore closer to the source of pain, however, the medication is placed away from the disc, without any guarantees that it will flow to the front epidural space where the disc-nerve root pathology is occurring.
The transforaminal technique requires fluoroscopic guidance for precise needle placement. This technique is favored by some, because of the precision with which solutions can be delivered to a specific nerve root and the front location of the needle in the epidural space. If fluoroscopy is not available, generally the caudal route is preferable for disc pathology at the L5/S1 level and the translaminar route for lesions above this level.
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