Injection Therapy for Herniated Disc in the Lower Back: A Non-Surgical Treatment Option

This pressure can cause symptoms such as lower back pain, sciatica radiating from the hip to the leg, numbness, tingling, and in advanced cases, muscle weakness.

In most patients, improvement can be achieved with medication, rest, and physical therapy. However, in some cases, the pain becomes chronic and severely restricts daily life. At this point, injection therapies become an effective method, either as an alternative to surgery or to delay it.

What is Injection Therapy?

Injection therapy for a slipped disc involves injecting corticosteroids and local anesthetics into the target area to reduce inflammation and swelling around the nerve root.

The aim of the treatment is:

• To reduce inflammation and swelling on the nerve
• To quickly control pain
• To increase the patient's mobility
• To facilitate adherence to physical therapy
• To delay or eliminate the need for surgery

Types of Injections Used for Slipped Discs

The method to be applied is determined according to the patient's complaints, the level of the herniation, and the affected nerve.

1. Epidural Steroid Injection

This is the most commonly used method. The medication is administered into the epidural space surrounding the spinal cord, aiming to reduce overall inflammation.

2. Transforaminal Injection

The medication is directly applied to the foramen region where the nerve exits the spinal canal. It is particularly effective in patients with unilateral leg pain (sciatica).

3. Caudal Injection

This is performed by entering through the sacral hiatus (tailbone area). It is preferred in cases affecting a wider area.

4. Facet Joint Injection

If the pain originates not only from the disc but also from the facet joints in the posterior spine, the treatment is applied to these joints.

Who Is It Suitable For?

Injection therapy may be preferred for the following patients:

• Those with severe sciatic pain due to a lumbar disc herniation
• Those whose pain does not subside despite medication and physical therapy
• Patients whose daily lives are restricted due to pain
• Those who are not suitable for surgery or wish to postpone it
• Patients with high surgical risk

Who Is It Not Suitable For?

In some cases, injection therapy is not suitable:

• Active infection
• Conditions requiring emergency surgery, such as urinary/fecal incontinence or sudden onset of severe muscle weakness
• Bleeding disorders or significant use of blood thinners
• Allergy to the medications used
• Uncontrolled diabetes (relative risk)

How Is the Procedure Performed?

Injection therapy is performed in a hospital setting, under sterile conditions, and with imaging guidance:

1. Preparation: The patient is placed in the appropriate position, and the procedure area is sterilized.
2. Local anesthesia: The skin is numbed to reduce pain during the procedure.
3. Image-guided application: The needle is guided to the target point using fluoroscopy or ultrasound.
4. Medication injection: A mixture of corticosteroid and local anesthetic is administered.

The procedure usually takes 10–20 minutes.

Post-Procedure Process

• The patient is kept under observation for a short period and is usually discharged on the same day.
• Mild pain or tenderness may be experienced during the first 24–48 hours.
• Pain reduction begins from day 3.
• The medication's effect reaches its maximum level within 1–2 weeks.
• Exercise and physical therapy may be recommended during this period.

Duration of Effectiveness

The effect of the injection varies from person to person. It may last weeks in some patients and months in others. It can provide long-term relief in suitable patients. If necessary, it can be repeated at specific intervals.

Possible Side Effects

It is generally a safe procedure. Rarely, the following may occur:

• Temporary pain at the injection site
• Short-term numbness or loss of sensation
• Facial flushing
• Temporary blood sugar elevation in diabetic patients