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Related Experiment Videos

Manipulation under epidural anesthesia with corticosteroid injection: two case reports

D D Aspegren1, R E Wright, D E Hemler

  • 1National College of Chiropractic, Lombard, IL, USA.

Journal of Manipulative and Physiological Therapeutics
|January 22, 1998
PubMed
Summary

Combining epidural steroid injection (ESI) and spinal manipulative therapy (SMT) offers a promising approach for persistent lumbar radiculopathy. This integrated procedure, including manipulation under epidural anesthesia (MUEA), demonstrated significant pain relief and functional improvement in two patient cases.

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Area of Science:

  • Neurology
  • Orthopedics
  • Pain Management

Background:

  • Lumbar radiculopathy can be challenging to treat, often requiring multimodal therapeutic strategies.
  • Recalcitrant cases may not respond adequately to conventional treatments like physical therapy, oral medications, or standalone spinal manipulative therapy (SMT).

Observation:

  • Two patients with persistent lumbar radiculopathy, one post-discectomy with scar formation and another with L4 intervertebral disc (IVD) syndrome, experienced limited relief from standard care.
  • Conventional treatments including physical therapy, SMT, and epidural steroid injection (ESI) provided only short-lived symptom improvement.

Findings:

  • An integrated approach combining SMT with ESI, specifically manipulation under epidural anesthesia (MUEA), was employed.
  • Both patients exhibited marked improvement in pain scores (Visual Analogue Scale, Oswestry Disability Index) and functional outcomes post-MUEA.

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  • The second patient, who received MUEA without prior ESI, also showed significant reduction in back and leg pain, with a negative Straight Leg Raise test.

    • Implications:

    • The combined use of ESI and SMT, particularly the MUEA technique, shows potential as an effective treatment for recalcitrant lumbar radiculopathy.
    • This integrated procedure may offer synergistic benefits, warranting further investigation and consideration within the healthcare industry for managing complex spinal conditions.