Steroid vs. Platelet Lysate Epidurals: One Woman’s 10-Year+ Result
Epidural steroid injections for sciatica have been a mainstay of treatment for many years. However, while they generally work, they have some serious downsides. Hence, more than a decade ago we changed to using the patient’s own growth factors to treat irritated spinal nerves. A patient I just saw this week is a great demonstration of why we switched. Let’s dig in.
What is an Epidural Injection?
The first concept to understand is understanding the term “epidural”. We doctors love to use Latin names, hence “epi” means “above” and “dural” means the covering of the spinal cord and nerve roots. Hence, epidural simply means injecting in the space between the spinal nerve and the disc. This space is filled with fat for cushioning and allows substances to be injected.
The most common type of epidural that people have heard of is the one used for pregnancy. This is where the doctor takes a special needle and at the bedside, inserts a catheter into the epidural space, often blind without guidance. An anesthetic is then applied to provide a nerve block for pregnancy pain. However, what’s done to treat sciatica for back pain is very different.
To treat an irritated spinal nerve, the doctor must first identify the right level to treat on a physical exam and on the MRI, as this type of epidural is more a sniper shot than the shotgun approach described above. The doctor then uses x-ray guidance (fluoroscopy) to place a needle in the area where the spinal nerve exits, called the foramen. A small amount of contrast is injected to make sure that the fluid flows between the right disc and the right spinal nerve.
How is this Type of Injection Commonly Used?
Sciatica, bulging discs, or irritated spinal nerves usually warrant a trial of epidural injections before surgery. We used this type of treatment for years with steroids, but the problem was that the results were often short-lived. One way to describe it was they were like a “sugar high”. The pain went away quickly, but then the patient often crashed hard with a return of the same or more severe pain in weeks.
Steroids vs. Platelet Lysate
We know through many studies going back decades that injecting corticosteroids (strong anti-inflammatory medications) into a patient causes tissue damage. I remember reading those studies many years ago and being blown away when I learned just how nasty these medications could be to local tissues. That knowledge is what pushed me to begin using platelet lysate instead. What’s that?
Platelet lysate is made by taking platelet-rich plasma (PRP) and breaking open the platelets to get the healing growth factors out. So if PRP is like a timed-release pill in that the platelets excrete healing growth factors, cytokines, and exosomes over about a week, platelet lysate is like an immediate release pill in that all of those things are removed and become available for use. To learn more, watch my video below:
In and around 2007 or so we began to use platelet lysate for epidurals. What we began to see was much better results than with steroids. Basically, patients began getting much longer relief without that nasty “sugar high” rebound. In addition, we knew that by skipping the steroids, what we were injecting was much kinder to the patient’s tissues.
One Woman’s Story
Last week, I saw a patient back in the clinic who was ten years out from her treatment at our clinic. She had low back pain with an irritated spinal nerve causing sciatica and our treatment back in 2010 had given her ten years of relief form her back and leg pain. She was returning to get another procedure.
What’s fascinating is that this woman was from that time period in our practice when we were slowly transitioning our patients from steroids to platelet lysate. Hence, she had gotten a single epidural steroid injection from us, but that didn’t work. She had that “sugar high” type result. Meaning she only felt better short-term. We then used a platelet lysate epidurals. That treatment resulted in a decade of relief.
A Grateful Physician
A few years back, I was at a medical conference and one of our affiliate physicians came up to me. I have to admit I was a bit concerned, as this doctor had been tough to onboard onto our network as he was very skeptical about how well Regenexx would work but he had been forced by his partners who wanted to join. However, this time, he had a big smile on his face. He proceeded to tell me that as an interventional spine physician he just wanted to thank me. The single biggest thing that we had taught him that had revolutionized his practice was epidural platelet lysate. The results he was seeing versus what he used to see with epidural steroids were nothing short of amazing.
The upshot? Based on our decade-plus experience, platelet lysate is a game-changer in spine care. For this woman, it resulted in a decade of relief rather than a “sugar high” steroid result. In addition, I as her doctor felt good about not injecting a toxic substance into her body, but simply her own growth factors, cytokines, and exosomes.