SpU: Is the over-all success rate of spinal epidural corticosteroid injections good?
Dr. Kamhi:
As stated earlier, an accurate diagnosis is most important. In my clinical experience, epidural corticosteroid injections are very effective to help relieve pain and paresthesias in patients with spinal radiculopathies caused by disc herniation. I should add that patients often require more than one epidural corticosteroid injection to obtain definitive and long-lasting relief. Many of my patients are highly satisfied with the results following a short series of epidural corticosteroid injections.

On the other hand, leg pain felt on exertion (neurogenic claudication) because of spinal stenosis is difficult to treat using epidural corticosteroid injections. The effects often do not produce long-lasting symptom relief.

In my practice, patients with nerve compression because of bony spinal stenosis do respond favorably to epidural corticosteroid injections. Sometimes this type of spinal stenosis is treated surgically (laminectomy, foraminotomy). However, some patients with bony spinal stenosis do not want to undergo spine surgery or are poor surgical risks. For those patients, a combination of epidural corticosteroid injections (spaced months apart), careful use of oral medication and physical therapy enables many patients to live and function reasonably well.

SpU: The population in the United States is growing older. What affect do you think this will have on pain management?
Dr. Kamhi:
Yes, I think as the American population grows older - and heavier in body weight too - physicians will be called on to see more and more degenerative arthritic diseases affecting bones, joints and the spine. Clinically speaking, the majority of my patients are 'baby boomers' or older. We see more osteoarthritis and spinal stenosis now than we used to and cases are likely to increase. Also, we see more disc herniations because of obesity and more chronic degenerative disease of the spine overall. Patients have come to expect that modern medicine will just devise ways to reduce pain and increase mobility among people in their golden years. I do think we, in Spine and Pain Management, should be prepared for such challenges.

Treatments like epidural corticosteroid injections and newer, more sophisticated minimally invasive spine interventions are coming into use and will no doubt be in greater demand as the American population ages in greater number. And, I think it's great that we now have Internet sites like SpineUniverse.com as reliable resources for physicians and patients alike.

SpU: Thank you Dr. Kamhi.