Lumbar spinal injections can help reduce back and leg pain and are a highly requested treatment at our offices.

But there are also plenty of misconceptions about them.

Can epidurals be a first-line treatment for low back pain? How well can they help us determine a source of pain? Can injections heal discs?

We brought on Dr. Joseph Zuhosky, who recently joined our team at Carolina Neurosurgery & Spine Associates, to get answers to these questions and more. Along the way, we hope to alleviate some myths and points of confusion about spinal injections.

Joe gives us his recommendations for when – and how – to treat pain with epidurals, explaining how they can not only help treat pain, but also help narrow down a pain’s source and identify further treatment.

“​​I think there definitely is a role for epidural steroid injections in identifying pain generators. And if it doesn't give our patient long-term, effective relief that they can live with, it helps our surgical partners to determine that it is, indeed, a level that we can reliably operate on.”

Toward the end of this episode, we also hear more about Joe’s personal experiences with disc herniations and how he’s been able to recommend exercises based on his own experience with the workout group he co-founded.

 

💡 Featured Expert 💡

Name: Joseph P. Zuhosky, MD

What he does: Before joining us recently as a physician at Carolina Neurosurgery & Spine Associates, Dr. Zuhosky went to medical school at The Ohio State University. He did his residency at the Rehabilitation Institute of Chicago at Northwestern University McGaw Medical Center and completed a fellowship, training in sports and spine rehab, at the Illinois SPINE & Sportscare Centers, Ltd. in Bloomingdale, Illinois.

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “I don't think we should take all the credit for healing the disc … it's a thought of managing it going forward because even when the pain isn't there, you still have a weak area of your body that you're going to have to compensate for going forward.”

Connect: Website

 

⚓ Anchor Points ⚓

Top takeaways from this Back Talk Doc episode

★    Injections are more than just a band-aid. Some patients worry that getting a spinal injection will only be a temporary fix for their pain. But it actually does a lot more than that, as long as the injections are used appropriately. While pain relief may only be temporary, an injection can tell us more about where the pain comes from and gives us clues on further ways to treat the patient.

★    A ‘series of three’ injections can limit treatment options. The ‘series of three’ injections myth stems from a research study on sciatica originally published in 1960, but further research found this treatment is only effective two times out of three. Since doctors can only give a limited number of injections within a period of time, this method can also rule out other treatment options that offer quicker relief.

★ An epidural is only one part of treatment. While a shot can relieve pain, it can’t actually heal a damaged disc. Instead, the epidural steroid reduces the swelling and inflammation that causes pain, getting the patient through the acute stage while Mother Nature does the rest of the work.

 

⚕️ Episode Insights ⚕️

[00:00] Check out our sponsor: QxMD builds mobile solutions that drive evidence-based medicine and clinical practice.

[01:59] Meet Dr. Joe: Joseph Zuhosky is the newest member of Carolina Neurosurgery & Spine Associates. Before joining us, he did his residency at the Rehab Institute of Chicago at Northwestern University and a fellowship in sports and spine rehab in Bloomingdale, Illinois.

[04:05] From pediatrics to orthopedics: Dr. Zuhosky talks about his varied interests as a medical student, beginning in pediatrics and eventually landing in spine health.

[06:32] Fact or fiction: Lumbar spinal injections are a type of corticosteroid that can reduce inflammation and alleviate back pain in the back and leg. We clarify some misconceptions about the injections.

[07:33] Low back pain: Though a lot of patients seek lumbar spinal injections for low back pain, epidurals generally have a low success rate among this population.

[10:59] Specificity: An injection can be helpful in determining a source of pain and ways to treat it, as long as the injection is done appropriately.

[15:02] Series of three: Originally introduced in a 1960 paper, the ‘series of three’ injection treatment strategy is a myth: Since the number of injections that can be given to a patient is limited, this practice could limit further treatment options.

[18:49] Discs: The steroid injection does not necessarily “heal” a disc, but it does reduce the inflammation and pain caused by a herniated disc and can help patients through the acute healing phase.

[22:18] Spinal stenosis: There are advantages to using lumbar epidural injections to treat spinal stenosis, but to suggest that they can heal this condition is misleading. Spinal stenosis was discussed on a previous episode with Dr. Joe Cheatle.

[26:38] Center or side: A transforaminal epidural – or when the epidural is injected directly to the nerve root rather than off-center – tends to have a slightly higher response rate.

[34:22] Personal experience: Dr. Zuhosky has personally experienced both lumbar and cervical hernias. He recommends a workout group with branches across the country called F3 that has helped with his lower back pain.

[40:15] Hamstring exercises: Dr. Zuhosky tells us more about hamstring stretches that won’t aggravate the back.

 

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.