Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica

Abstract

Background: Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. On the other hand, there has been a great increase in Germany in the number of spinal operations due to degenerative spine disease and, in turn, unnecessary surgery on the spine is under debate.

Methods: This is a narrative review of different minimally invasive spine procedures in the treatment of specific low back pain. The effectiveness of spinal injections, radiofrequency of the facet joints as well as epidural adhesiolysis/neurolysis are described. An analysis of the literature was performed via PubMed, Medline and the Cochrane Database.

Results: Facet-, epidural and intradiscal steroid injections for specific pain generators in the degenerative spine show different short- and long-term results; they are able to improve low back pain in specific patients with chronic low back pain and may be able to prevent some of these patients from having to undergo open surgery. Furthermore, there are promising results from interventions such as epidural neurolysis for sciatica and radiofrequency of the medial branch of the dorsal root for the treatment of axial facet-related back pain. Facet and intradiscal steroid injections give only short-term effects in axial low back pain and should therefore only be considered reluctantly, whereas the different forms of epidural steroid injections in patients with sciatica due to radicular compression offer a well proven adjuvant treatment option within a conservative therapeutic regimen. The overview of the literature with the use of different steroids has shown that use of non-particulate steroids show better results with respect to the safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off label and patients have to give informed consent prior to injection. In summary, careful use of spinal injections and interventions within a conservative physiotherapeutic regimen seem to improve chronic back pain and, in turn, to be able to prevent some patients from having to undergo spine surgery.