8.AUG.2016 3 MIN READ | 3 MIN READ

What would you do if you were suffering from back pain caused by an injury, and neither medication nor physiotherapy helps?

Would you choose an open surgery on your back, or would you opt for an injection that would relieve your pain and takes less than 2 hours?

Most back injuries are short-term, caused by sprains to the back muscles. Serious, long-term back pain, however, are usually caused by structural damage to your spinal cord. “Spinal stenosis, for example, is a case where the spinal space narrows, causing pressure on the spinal cord and nerves,” says Dr Benjamin Tow, an orthopaedic surgeon practising at Mount Elizabeth Hospital, Singapore. “Another cause for severe back pain is a slipped disc, or disc herniation, where the soft tissue between the spine bones protrudes, impinging on the nerves.”

If the injury is slight, it is possible to be cured through medication that reduces the inflammation on the nerves, and through physiotherapy to correct poor posture. However, when the condition is serious, the only cure is often spinal surgery, which can be daunting for many people.

A temporary and limited relief

Epidural steroid injections are options that some patients might prefer. “Anaesthetics and steroids are injected that will reduce the inflammation of the nerves. The injection usually takes less than 2 hours, and the patient can go home right after,” Dr Tow says. The short procedure time also means that the procedure is inexpensive.

What many do not realise, however, is that an epidural steroid injection is not a cure. While the risks of the procedure is low, what it does is reduce or remove the pain for a limited period of time. “The duration of effect is variable and temporary,” Dr Tow explains. “In most cases, the pain relief may only last 2 to 3 weeks as the medications injected will be metabolized and removed by the body tissues. However, in some cases the effect is longer lasting if the inflammatory process is halted by the injection and your back pain will not relapse.”

Risks of steroid injections

It is also not advisable to rely on epidural injections as a long term solution to your persistent back pain. The steroid injections can result in a weakening of the bones, muscles and tissues in the spine, and the body can build up resistance against the effect of the steroids. This means that not only will repeat injections have less effect, they may even worsen your condition.

In short, these injections are considered as short-term treatment for immediate pain relief. Dr Tow says that patients suffering from severe or chronic back problems will find that surgery tends to be the only way to cure the problem once and for all.

Minimally invasive options for back pain

Thankfully, medical advancements have resulted in minimally invasive procedures for many back problems. Spinal stenosis, for example, can be treated using minimally invasive laminectomy, where parts of the vertebra are removed to relieve pressure on the nerves. “Some patients suffering from herniated disc can also be treated through disc nucleoplasty,” Dr Tow explains, “where a special radio-frequency ablation needle is used to decrease the internal pressure in the disc, decreasing the impingement on the nerves and spinal cord.” In the case of disc nucleoplasty, it can even be just as fast as the epidural injection.

 “An epidural steroid injection is an effective interim solution for your back pain relifem, suitable for patients when surgery is either not feasible or not immediately available,” Dr Tow concludes. However, if you really want to get rid of your back pain in the long run, surgery might be the only, and best choice.

8.AUG.2016
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Tow Phak Boon Benjamin
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Benjamin Tow is a spine surgeon practising at Mount Elizabeth Hospital, Singapore. He specialises in treating degenerative conditions of the spine, deformity surgery and minimally invasive spine surgery, as well as percutaneous injections for spine conditions.