Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Epidural Cortisone Injections for Sciatica From
Herniated Disc...Beneficial?
Epidural Cortisone Injections for Sciatica From
Herniated Disc...Beneficial?
Medical Author: Medical Author: William C. Shiel Jr., MD, FACP, FACR
The discs of the spine are located
between the vertebrae (bony building blocks of the spine).
The disc is designed somewhat like a jelly donut being composed
of an inner gelatin-like core (the nucleus pulposus) surrounded
by a firm outer ring (the annulus fibrosus).
When the disc structure wears, because of processes
such as aging or trauma, it becomes weakened and susceptible to
injury. In this condition, stresses on the spine can cause the
inner core to protrude outward through the boundary of the disc's
outer ring. The is referred to as herniation of the disc.
Disc herniation can directly press upon the spinal
cord and/or adjacent nerve tissues resulting in pain which radiates
outward from the spine in the distribution of the affected nerve.
When the disc herniation is in the spine of the lower back, it
can cause a radiating pain down the legs, commonly referred to
as sciatica.
A majority of patients with sciatica from disc herniation
have resolution of their pain with various conservative measures,
including antiinflammatory and muscle-relaxant medications, exercises,
physical therapy, and time. However, some 10%-15% of affected
patients require surgical procedures to relieve the pain.
The vertebrae are the bony building
blocks of the spine. Between each of the largest parts (bodies) of the vertebrae
are the discs. Ligaments are situated around the spine and discs. The spine has
seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back
(thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In
addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum,
followed by the tailbone (coccyx).
The bony spine is designed so that vertebrae
"stacked" together can provide a movable support structure while also protecting
the spinal cord (nervous tissue that extends down the spinal column from the
brain) from injury. Each vertebra has a spinous process, which is a bony
prominence behind the spinal cord that shields the cord's nerve tissue. The
vertebrae also have a strong bony "body" in front of the spinal cord to provide
a platform suitable for weight-bearing.
The discs are pads that serve as
"cushions" between the vertebral bodies that serve to minimize the impact of
movement on the spinal column. Each disc is designed like a jelly donut with a
central softer component (nucleus pulposus). Ligaments are strong fibrous soft
tissues that firmly attach bones to bones. Ligaments attach each of the
vertebrae and surround each of the discs. When ligaments are injured as the disc
degenerates, localized pain in the area affected can result.
What is a herniated disc? What causes it?
As described above, each disc of the spine is
designed much like a jelly donut. As the disc degenerates from age or injury,
the softer central portion can rupture (herniate) through the surrounding outer
ring (annulus fibrosus). This abnormal rupture of the central portion of the
disc is referred to as a disc herniation.
The most common location for a
herniated disc to occur is in the disc at the level between the fourth and fifth
lumber vertebrae in the low back. This area is constantly absorbing the impact
of bearing the weight of the upper body. This is especially important when we
are standing or sitting. The lower back is also critically involved in our
body's movements throughout the day, as we twist the torso in rotating side to
side and as we hinge the back in flexion and extension while bending or lifting.
Picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
Cauda equina syndrome is an uncommon compression of the nerves at the end of
the spinal cord within the spinal canal. The terminology, "cauda equina,"
literally means tail of horse and refers to the normal anatomy of the end of the
spinal cord in the low back where it divides into many bundles of nerve tracts
resembling a horse's tail. Compression of the spinal cord at this level can lead
to a number of typical symptoms of the syndrome (low back pain,
sciatica, saddle
sensory changes, bladder and
bowel incontinence, and lower extremity motor and
sensory loss).
What are the causes of cauda equina syndrome?
Cauda equina syndrome can be caused by any condition that results in direct
irritation or pinching of the nerves at the end of the spinal cord. Causes of
cauda equina syndrome include herniation of lumbar intervertebral discs,
abnormal growths (tumor or cancer) adjacent to the ...
