At PDR clinics we strive to include patients in our decision making process. Shared Decision Making is when physicians and patients collaborate in order to make informed decisions using current research, best practice guidelines, and patient values and preferences. Below are links to help guide you through different decisions that you may currently be facing.
- Should I get an Epidural Steroid Injection?
- Should I get an MRI?
- Should I have Spine Surgery?
Should I get an Epidural Steroid Injection?
It is an injection of a steroid into your spinal canal. It is usually done under X-ray guidance to be sure that the medicine goes to the exact location that is causing your symptoms. Steroids reduce inflammation and swelling. This can relieve pressure on the nerve roots.It will not fix your spine, but it can give short-term relief of symptoms. It is not recommended to have more than 3 shots in the same location per year.
You may consider an Epidural Steroid Injection (ESI) if you have neck or lower back pain that is spreading down your arm or leg, and the pain has been ongoing for greater than 6 weeks and is not responding to physical therapy. You may consider an injection if you are in physical therapy and pain is limiting you from tolerating spinal strengthening. If you do not have pain down your leg or arm, it is unlikely that an epidural steroid injection would help. It is not recommended for generalized, nonspecific neck or back pain.
The risks are low and serious side effects are rare. The most common problem is a severe spinal headache that lasts for a few days. Your pain may also get worse before it gets better. There is a small chance of infection or bleeding at the site of the injection. The injection may not be effective. If the injection is effective, relief will generally last up to 3 months.
The benefit is temporary relief of pain for up to 3 months. This may be enough time for healing and recovery, so pain may not return. The injection may help you tolerate therapy and exercise more effectively if pain is limiting factor. It is also significantly lower risk than surgery. Injections can help delay surgery.
Other treatment options consist of exercise, maintaining a healthy body weight, medications (Tylenol, Ibuprofen, Naproxen, etc.), Ice, physical therapy, MEDX spinal rehabilitation, surgery.
Should I get an MRI?
An MRI creates pictures of your spine, using a magnetic field. You are placed in a machine that contains a strong magnet. In some cases a contrast material is injected through an IV. Because 85% of patients with neck and back pain have no structural deformities, an MRI is not a standard test for neck and lower back pain. Most neck and lower back issues are caused by muscle, ligament or soft tissue dysfunction/injury.
An MRI is helpful for detection of serious conditions, such as infections or tumors. It can also be helpful in detecting specific problems, such as disc herniations, especially if other treatment options are being considered such as injections or surgery. An MRI generally does not change your treatment plan, so it is usually not needed for the treatment of neck and back pain. Most episodes of neck and back pain resolve with time or with physical therapy. An MRI may be considered for neck or back pain that persists after 6 weeks of spinal rehabilitation with no improvements.
There are no known harmful effects of MRIs. MRIs are expensive, loud, and usually do not alter your treatment plan. They usually require you to be confined to a small space for 30 to 60 minutes, so they can be difficult if you are claustrophobic. MRIs can create unnecessary stress and anxiety by revealing detailed signs of usual wear and tear that is most often not even the source of symptoms, and they have a high false positive rate.
MRIs can be helpful if injections or surgery are being considered to help with treatment planning.
Most of the time the cause of your neck and back pain can be diagnosed by a good physical examination by a physician. If your symptoms get better with spinal rehabilitation, then an MRI will not be necessary.
Should I have Spine Surgery?
There are different types of spine surgery. In some cases, the surgeon removes extruded disc material to relieve pressure on nerve roots and/or the spinal canal. The purpose of surgery is generally to relieve pressure on nerve roots and/or the spinal canal and to preserve neurological structures.
Generally, spine surgery is only considered when there are progressive neurologic deficits related to neck or back injury. This can include progressive weakness, loss of bowel, and/ or bladder function. Due to high risks involved, surgery is almost always the last resort.
Common risks can include infection and bleeding at the site of the surgery, poor efficacy, prolonged recovery, and post-surgical pain. Rare but serious complications can include severe infections, paralysis, respiratory issues, complications from anesthesia and death.
Benefits of surgery can be quicker relief of pain symptoms if surgery is successful and without complication. Spine rehabilitation is a good idea after surgery. It helps rebuild the muscles that were injured in the surgery for a more complete recovery and the best outcome.
Other options to surgery are Exercise, maintaining a healthy body weight, medications (Tylenol, Ibuprofen, Naproxen, etc.), Ice, Physical therapy, MEDX Spinal rehabilitation, and Injections.