Stemcelldoc's Weblog

June 6, 2013

Successful Treatment of Sciatica: Disc Herniation Location and Clinical Success

At the Centeno-Schultz Clinic knowing which patients will benefit from which procedure is key.

Sciatica due to a lumbar disc herniation can respond favorably to epidural steroid injections. The location of the disc herniation can dictate success.  Previous blogs have discussed the  successful treatment of sciatica with platelet epidural injections (Regenexx PL-M).  Pre and post MRI studies have demonstrated reduction in disc herniation which corresponded with clinical symptoms.

At recent study confirmed what we have known clinically for years.  Lee et al demonstrated that patients with herniated lumbar discs in the foraminal or extra-foraminal zone had excellent clinical response to transforaminal epidural injections.

Basic Definitions

Foramen:  Opening

Neural Foramen:  Boney doorway through which of the spinal nerve root, dorsal root ganglion, the spinal artery pass.

neural  foramen

Foraminal zone:  The zone between planes passing through the medial and lateral edges of the pedicles.

The spinal canal can be divided into three zones:  central, foraminal and extra-foraminal.

Spinal Canal Zones

Spinal Canal Zones

There are two principle types of epidural injections:  transforaminal and interlaminar.  The former is directed towards the neural foramen and exiting nerve root whereas the latter is injected into the posterior epidural space.  Successful treatment is knowing the location of the disc hernation and providing the appropriate epidural injection.  This is the standard of care at the Centeno-Schultz Clinic.

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