Epidural Steroid Injections of the Neck and Back: Minnesota Workers’ Compensation

Epidural injections deliver steroids into the epidural space around the spinal nerve roots to relive pain caused by irritated spinal nerves. The steroid reduces inflammation of the nerves, which are often the source of pain. About 50% of patients receive significant pain relief following an injection. The purpose of epidural steroid injections is to help patients get enough pain relief in order to be able to undergo rehabilitation program. Unfortunately, epidural steroid injections don’t actually cure the underlying problem.

Spinal nerves can become inflamed due to irritation from a damaged disc or contact with bone spurs. Symptoms of nerve inflammation can cause pain and/or numbness and tingling in parts of the body associated with the nerve.

Nerve irritation in the cervical spine can cause:

• Neck pain, tingling, or numbness. 
• Shoulder pain, tingling, or numbness. 
• Arm pain, tingling, or numbness. 

Nerve irritation in the thoracic spine can cause:

• Upper back pain. 
• Pain along the ribs to the chest wall. 
• Pain in the abdomen. 

Nerve irritation in the lumbar spine can cause:

• Low back pain. 
• Hip pain. 
• Buttock pain. 
• Leg pain, tingling, or numbness. 

Before the injection is administered, the patient is given a local anesthetic to the area that is to be injected. The injection is performed using a guided x-ray procedure called fluoroscopy. Contrast dye and a combination of numbing medicine and an anti-inflammatory medicine are injected into the epidural space. The procedure generally takes about 30 minutes, followed by approximately 45 minutes of recovery time. Some patients may experience partial numbness from the anesthetic in the arms or legs, which usually subsides after a few hours. Pain levels after an epidural steroid injection should be documented in a “pain diary” so the treating physician can evaluate the effectiveness of the injection. Improvements in pain will generally occur within 10 days after the injection, and may begin as soon as one day after the injection.

For more information about spinal epidural injections check out Spine-Health.com.

Workers with neck and back injuries frequently undergo one or more epidural steroid injections, with varying degrees of success. If you’ve sustained an on-the-job injury, contact Meuser & Associate for a free, no obligation consultation to learn more about your Minnesota workers’ compensation rights. Call us at 877-746-5680 or click here to send us an email. 

Work-Related Herniated Disc: Non-Surgical Treatment Options

Low back herniated disc injuries are the most common work-related injury we see in our Minnesota workers’ compensation practice. 

While a good portion of our clients do ultimately require some sort of surgery to address their herniated discs, many of our clients experience improvements in their condition, or they are able to manage their symptoms through other, non-surgical medical treatments.

During the initial time period following a lumbar herniated disc injury, many patients will try a variety of “conservative” treatments to alleviate pain from the herniated disc, and to give the disc herniation time to heal. If an injured worker experiences symptom relief with non-surgical options within the first several weeks following the disc herniated injury, continued non-surgical treatment may be appropriate.

Some types of non-surgical disc herniation treatment options include:

Chiropractic treatment and physical therapy. If symptoms persist for several weeks, a trial of chiropractic or osteopathic manipulation and/or physical therapy may be warranted. The goals of chiropractic/osteopathic manipulation and physical therapy are to reduce pain and to help the patient return to his or her normal level of function.

Medications. Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain caused by a disc herniation. Oral steroids may also be utilized to try to reduce inflammation promote healing of a herniated disc. Narcotic pain medications may be prescribed to reduce acute pain. Muscle relaxers may be prescribed to reduce muscle spasm, and to encourage healing in the affected area.

Epidural steroid injections. Injections of steroids directly into the area of the disc herniation can help reduce inflammation and promote healing. Patients may experience pain relief that can last from one week up to a year. Up to three injections may be done within a year.

In Minnesota, if you sustain a work-related herniated disc, the workers’ compensation insurance company is required to pay for reasonable and necessary medical expenses, which may include chiropractic treatments and physical therapy, medications, and injections, and a variety of other medical treatments.

Lumbar herniated discs can be extremely painful and can seriously interfere with your ability to work. Herniated discs are the most common work-related injury we see in our workers’ compensation practice. To learn more about your Minnesota workers’ compensation rights, call Meuser & Associate at 877-746-5680, or click here to send us an email to schedule a free, no-obligation case consultation. 

Cortisone Injections, Epidural Steroid Injections, and Other Therapeutic Injections for Work Injuries

If you’ve sustained a work injury, your doctor may prescribe a cortisone injection, epidural steroid injection, or other therapeutic injection procedure. 

Often, cortisone injections, epidural injections, and other therapeutic injections, are considered an “intermediate” treatment, falling somewhere in between conservative therapies and more drastic procedures, such as surgery.

These therapeutic injections are covered by Minnesota workers’ compensation if they are reasonable and necessary to cure or relieve the effects of your work related injury.

Cortisone Injection

Cortisone injections are injections of a synthetic corticosteroid (cortisol) medication into an affected area of the body. Injections of cortisone are used to suppress immune response which in turn can decrease inflammation and pain. A numbing medication, such as novacaine, is typically mixed with the cortisone to provide some immediate relief and to help the cortisone spread throughout the affected area.

Cortisone injections are typically used to treat inflammatory problems that can cause pain and loss of function, including arthritis, epicondylitis (“tennis elbow”), trigger finger, de Quervain’s tenosynovitis, trochanteric bursitis of the hip, subacromial bursitis of the shoulder or shoulder impingement syndrome.

The relief provided by cortisone injections varies from person to person. Typically, cortisone starts to take effect within about a week, but may take up to two weeks to reach maximum effectiveness. Sometimes, cortisone injections don’t work for some people. In that case, it may be that your problem is not primarily an inflammatory condition, or your condition is too far along in its course for cortisone to provide relief.

Epidural Steroid Injection

Epidural steroid injections are very similar to cortisone injections, except that they are done on the spine. Epidural steroid injections are injections of corticosteroid medication and local anesthesia (numbing medication) into the lumbar, thoracic, or cervical spine, using a needle and syringe. This type of injection is aimed at providing relief from neck or back pain.

When nerve roots are irritated by a bulging or herniated disc, or by degenerative conditions such as spinal stenosis, it can cause pain and numbness, which may extend from the neck into the shoulders and arms, or from the back into the buttocks and legs.

The medication is injected into the epidural space around the nerve roots at the affected level of your spine. Epidural steroid injections work by reducing inflammation of the nerve roots, which is swelling and irritation, thereby providing pain relief. Some people receive immediate relief from epidural steroid injections, although it may take up to two weeks for the treatment to reach maximum effectiveness. Some people experience permanent relief of their neck or back pain following an epidural steroid injection, but for most people, the relief lasts for up to a few months.

Facet Joint Injection

Facet joints are small pairs of joints where vertebrae meet on the back side of the spine. These joints provide stability to spine by interlocking two vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist. Inflammation of the areas surrounding the facet joints can cause pain and discomfort.

Facet joint injections are very similar to epidural steroid injections, but they are aimed at relieving inflammation in the facet joints rather than the nerve roots.

Sacroiliac Joint Injection

The sacroiliac (SI) joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). This joint transmits all the forces of the upper body to the pelvis and legs and acts as a shock-absorbing structure. This “joint” does not have much motion. The sacroiliac (SI) joint can become inflamed from an acute injury or from chronic postural abnormalities. Pain from a sacroiliac joint problem occurs in the low back, buttock/hip, abdomen, groin, or legs.

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities. Undue stress on the joint following low back fusion surgery can also cause inflammation and pain here. Pain from sacroiliac joint abnormalities occurs in the low back, buttock/hip, abdomen, groin, or legs.

A sacroiliac joint injection can serve two purposes. First, the injection can be used as a diagnostic tool to confirm whether or not the pain is coming from that joint. Second, the local anesthetic and cortisone medication can provide symptom relief which can help facilitate a program of rehabilitation.

Neurotomy

Facet joints are pairs of small joints that separate the vertebra on the back side of the spine in the lumbar (low back), thoracic (mid-back), and cervical (neck) regions. These joints can become inflamed and painful from either injuries or arthritic conditions. When facet injections of local anesthetic and/or cortisone provide temporary pain relief, you may be a candidate for a facet neurotomy.

A facet neurotomy involves destroying the nerves that relay pain messages from the facet joints. This is accomplished by using a technology called Radio Frequency Thermal Coagulation (RFTC). Under x-ray guidance, your physician places a fine probe, not much larger than the needle used in facet injections, down to the nerves that supply the facet joint(s). A controlled heat lesion is then made using RTFC. Each facet joint has at least two nerve branches therefore several lesions may need to be done at the time of the procedure.

Neurotomies are more intensive procedures than epidural steroid injections or facet joint injections. Expect moderate pain for several days following the procedure, and it may take several weeks to experience the maximum effect of the treatment. A neurotomy can provide up to six months or more of relief.

There are several other types of minimally-invasive injection-based therapies available for people suffering from work injuries to the hips, knees, elbows, shoulders, neck or back. The workers’ compensation lawyers at Meuser & Associate can help you get the medical treatment you need to treat your work injuries. Call us at 877-746-5680 or click here to send us an email to schedule a free, no-obligation consultation.

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