Injections… Or, To Fuse Or Not To Fuse?
By Andrew M. Cash, M.D.
When treating spinal disc injuries, medical providers rely on historical data, physical examination findings, and corroborating imaging and data to decide which diagnostic and/or therapeutic treatments are best for patients. Most often these treatments comprise pain-blocking injections, or surgical infusions. Since spinal injuries are a large part of personal injury cases, below outlines a brief, slightly laypersons’ explanation of the treatments one can expect.
The cervical, thoracic and lumbar spines have segmental levels consisting of an anterior disc and two facet joints (one on the right side of the disc and one on the left side). Structurally, when a disc is injured, either the facets can be injured or the entire segment (disc and facets) can be involved. For a certain level of injury, injections are recommended on both a diagnostic and/or therapeutic basis; and if a medical provider anticipates that the majority of a patient’s pain is coming from a disc, a selective nerve root block—a “transforaminal epidural steroid injection”—is recommended.
Conversely, if it is suspected or determined that there is a facet-mediated source of pain, a facet injection (called a “medial branch block” ) is the recommended course of action. Further, when a facet injection provides substantial relief, a more long-term procedure (called a “radiofrequency ablation” ) is the next therapeutic step.
When The Fix Is Surgical
When selective transforaminal epidural steroid injections are diagnostic, the next therapeutic intervention is a spinal reconstruction (fusion) or discectomy, and of the disc surgeries, there are two that are most frequent: discectomies and fusions. It is typical that for cervical and thoracic spines, discectomies are usually performed with reconstructions. For the lumbar spine, discectomies are often performed without reconstructions. If a medical professional determines that the preponderance of the pain radiates down the buttocks and leg, then a lumbar discectomy is used to reduce the leg complaints. The patient will have persistent and potentially worsened back pain. If the preponderance of a patient’s pain is located in the low back, then a lumbar fusion is often included to reduce the patient’s lumbar complaints.