What You Should Know About Epidural Steroid Injections

What are epidural steroid injections?

Epidural corticosteroid injections place medication directly around a pinched nerve as it exits the spine within the epidural space. The epidural space is between the bones and discs of the spine, and the nerves and spinal cord. This is the space into which disc tissue can herniate and cause pressure and inflammation around spinal nerves.

What are epidural corticosteroid injections used for?

Epidural steroid injections are commonly used to treat back pain caused by a herniated disc (slipped disc), lumbar radiculopathy, spinal stenosis or sciatica. Corticosteroids are strong anti-inflammatory medications and, when placed into the epidural space, can significantly reduce inflammation around an irritated nerve that is causing back and leg pain and discomfort.

Who can benefit from an epidural steroid injection?

Patients with several common conditions – including lumbar disc herniation, degenerative disc disease, lumbar radiculopathy, sciatica, lumbar spinal stenosis, postherpetic neuralgia and facet/synovial cysts – may benefit from an epidural injection. An epidural steroid injection may be an effective nonsurgical treatment in itself or may aid in surgical planning.

How do epidural corticosteroid injections work?

Epidural steroid injections work by delivering a potent anti-inflammatory to the site of nerve impingement in the spine. Injected medications may include steroids, local anesthetics, and saline, and they can vary in volume and concentration on an individual basis.

Three routes may be used for epidural injections in the lumbosacral spine:

• caudal
• interlaminar (also known as translaminar)
• transforaminal

Your physician will choose which method is right for you based on your diagnosis and if you have had any prior spine surgeries.

• A caudal injection is the least complicated way to access the epidural space but is also the least specific. It can be useful if multiple areas of the spine are involved or if post-surgical changes prevent other approaches.
• An interlaminar (or translaminar) injection delivers the medication directly into the epidural space at the affected level, can be targeted to one side or the other, and can treat multiple levels at once.
• A transforaminal injection delivers the medication to the area where the specific affected nerve root exits the spine and is compressed by a disc herniation. It is the usual first choice approach for an epidural injection.

How often can you get epidural steroid injections?

Epidural steroid injections are recommended to be administered up to three to six times per year. In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common.

How long do epidural injections last for back pain?

Epidural steroid injections can help resolve pain permanently in patients with a new disc herniation who respond favorably. For patients with chronic pain or recurrent disc herniations, the desired duration of effect is three to six months or more.

What are the risks of epidural steroid injections?

The risks in any procedure involving a needle include bleeding, infection and nerve damage. When performed properly, the risk of any of these is exceedingly low and usually outweighed by the potential benefit of the procedure.

Some contraindications for performing epidural steroid injections include:

• bleeding disorders or anticoagulation
• medication allergies (rare)
• systemic infection or localized infection overlying the area

What are the side effects of epidural steroid injections?

Common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, or increased blood sugar. These are usually self-limited and resolve within one to three days. A less common side effect is headache.

Is any preparation required? Can I eat before and after my epidural steroid injection?

Your doctor will give you specific instructions and these will vary by facility and type of epidural (lumbar, thoracic or cervical). Because the procedure is usually performed with local anesthetic, fasting guidelines are not overly prohibitive.

Is any anesthesia used? Are epidural steroid injections painful?

A local anesthetic is injected into the skin, numbing the area where the epidural needle is then placed. Patients may experience mild discomfort but should not experience severe pain during the procedure.

Will I have to lie flat on my stomach for long during or after the procedure?

The procedure can last anywhere from 10 to 20 minutes and requires the patient to lie prone, if possible, to allow for X-ray guidance (fluoroscopy). After the procedure, you can sit, stand, and walk as usual after a short period of monitoring.

Who performs epidural steroid injections?

Epidural steroid injections at HSS are performed by several types of doctors – pain management physicians, physiatrists and interventional radiologists – all of whom are trained to safely perform this procedure, often with additional subspecialty fellowship training.

Updated: 9/15/2020

Authors

Anuj Malhotra, MD

Director, Ambulatory Pain Medicine Program, Hospital for Special Surgery
Assistant Attending Physician, Pain Management, Hospital for Special Surgery

Epidural Steroid Injection, ESI, spine injections Cincinnati, Ohio Mayfield Brain & Spine

Overview

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. Medicines are delivered to the epidural space, which is a fat-filled area between the bone and the protective sac of the spinal nerves. Pain relief may last for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.

What is an epidural steroid injection (ESI)?

A steroid injection includes both a corticosteroid (e.g., triamcinolone, methyl-prednisolone, dexamethasone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the bony vertebra and the protective dura sac surrounding the spinal nerves and cord (Fig. 1).

Figure 1. Side view of the spine. The epidural space is a fat-filled area that lies between the bony vertebra and the dura sac, which surrounds and protects the spinal cord and nerve roots.

Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. Unfortunately, the injection does not make a herniated disc smaller; it only works on the spinal nerves by flushing away the proteins that cause swelling. The pain relief can last from days to years, allowing your spinal condition to improve with physical therapy and an exercise program.

Who is a candidate?

Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

• Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
• Spondylolisthesis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, it can compress the nerve roots causing pain.
• Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
• Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
• Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

ESI has proven helpful for some patients in the treatment of painful inflammatory conditions. ESI can also help determine whether surgery might be beneficial for pain associated with a herniated disc. When symptoms interfere with rehabilitative exercises, epidurals can ease the pain enough so that patients can continue their physical therapy.

ESI should NOT be performed on people who have an infection or have bleeding problems. The injection may slightly elevate the blood sugar levels in patients with diabetes. It may also temporarily elevate blood pressure and eye pressure for patients with glaucoma. You should discuss this with your physician.

If you think you may be pregnant, tell the doctor. Fluoroscopy x- rays may be harmful to the baby.

Who performs the procedure?

Physicians who perform epidural steroid injections include physiatrists (PM&R), radiologists, anesthesiologists, neurologists, and surgeons.

What happens before treatment?

The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best approach for the injections. Be prepared to ask any questions at this appointment.

Patients who take take blood thinning medication (Coumadin, Plavix, etc.) may need to stop taking it several days before the ESI. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.

The procedure is usually performed in an outpatient center using x-ray fluoroscopy. Make arrangements to have someone drive you to and from the center the day of the injection.

What happens during treatment?

At the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. The procedure may last 15-45 minutes, followed by a recovery period.

The goal is to inject the medication as close to the painful nerve as possible. The type of injection depends on your condition and if you have metal rods or screws from previous surgery. The doctor will decide which type is likely to produce the best results.

Step 1: prepare the patient
The patient lies on an x-ray table. Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains awake and aware during the injection to provide feedback to the physician. A low dose oral sedative, such as Valium or Versed, may be offered depending on the center.

Step 2: insert the needle
With the aid of an x-ray fluoroscope, the doctor directs a hollow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy allows the doctor to watch the needle in real-time on the x-ray monitor, ensuring that the needle goes to the desired location. Some discomfort occurs, but patients more commonly feel pressure than pain.

There are several types of ESIs:

• Cervical ESI (neck). The needle entry site is from the side of neck to reach the neural foramen, just above the opening for the nerve root and outside the epidural space (Fig. 2). Contrast dye is injected to confirm where the medication will flow.

Figure 2. An ESI injection in the cervical spine for neck or arm pain. The needle is inserted from the side of the neck to reach the neural foramen to deliver the steroid medication (green) where the inflamed nerve root exits the spine.

• Lumbar ESI (low back). The needle entry site is slightly off midline of the back to reach the nerve canal (Fig. 3). Contrast dye is injected to confirm where the medication will flow.

Figure 3. An ESI injection in the lumbar spine for leg or low back pain. The needle is inserted from the back on the affected side to reach the epidural space to deliver steroid medication (green) to the inflamed nerve root.

• Caudal ESI (tailbone). The needle is placed in the sacral hiatus above the tailbone to reach the lowest spinal nerves. Contrast dye is injected to confirm where the medication will flow.

Step 3: inject the medication
When the needle is correctly positioned, the anesthetic and corticosteroid medications are injected into the epidural space around the nerve roots. The needle is then re­moved. Depending on your pain location, the procedure may be repeated for left and right sides. One or several spinal levels may be injected.

What happens after treatment?

Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the center. Rarely temporary leg weakness or numbness can occur; therefore someone should drive you home.

Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol).

You may want to record your levels of pain during the next couple of weeks in a diary. You may notice a slight increase in pain, numbness, or weakness as the numbing medicine wears off and before the corticosteroid starts to take effect.

Patients should schedule a follow-up appointment with the referring or treating physician after the procedure to document the efficacy and address any concerns the patient may have for future treatments and expectations.

What are the results?

Many patients experience some pain relief benefits from ESI [1,2]. For those who experience only mild pain relief, one to two more injections may be performed, usually in 1-4 week intervals, to achieve full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with a physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.

What are the risks?

With few risks, ESI is considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, and nerve damage / paralysis (rare).

Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work). Patients who are being treated for chronic conditions (e.g., heart disease, diabetes, rheumatoid arthritis) or those who cannot temporarily discontinue anti-clotting medications should consult their personal physician for a risk assessment.

Sources & links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Links
Spine-health.com
Spineuniverse.com

Sources

1. Weinstein SM, Herring SA: NASS. Lumbar epidural steroid injections. Spine J 3(3 Suppl):37S-44S, 2003.
2. Lutz GE, VAd VB, Wisneski RJ: Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 79:1362-1366, 1998.

anesthetic: an agent that causes loss of sensation with or without the loss of consciousness.

chronic: a condition of slow progression that continues over a long period of time, opposite of acute.

corticosteroid: a hormone produced by the adrenal gland or synthetically made. Regulates salt and water balance and reduces inflammation.

epidural space: the area between the membrane surrounding the spinal cord and the vertebral wall that is filled with fat and small blood vessels.

fluoroscopy: an imaging device that uses x-ray or other radiation to view structures in the body in real time, or “live.” Also called a C-arm.

sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar or 1st sacral spinal nerves.

updated > 7.2018
reviewed by > Marc Orlando, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

Michigan Neurology Associates & PC: Neurologists

Your spine is made up of individual bones, or vertebrae, and rubbery cushions between these bones known as discs. A herniated disc happens when one of the discs ruptures or slips out of place.

Depending on where the injury happens, you might experience a range of bothersome symptoms that worsen as time goes on. Steroid injections are a minimally invasive treatment option for reducing herniated disc symptoms when conservative treatments haven’t fully helped. 

Our team of experienced pain management experts at Michigan Neurology Associates provides epidural steroid injections as well as other interventions for chronic and acute back pain in a safe, efficient, ambulatory environment. Read on to learn more about this therapeutic treatment.

Herniated disc symptoms

A herniated disc can occur at any place on your spine. You can experience one without any noticeable symptoms, but when symptoms do crop up, they can range from mild or moderate to fairly severe. 

Depending on the location, a herniated disc may cause:

• Arm or shoulder pain that worsens when you cough or sneeze
• Leg pain that extends into your buttocks
• Muscle weakness and an increased risk for injury
• Nerve pain or damage
• Radiating numbness or tingling through part of your body

In severe cases that result in nerve damage, you might also experience bladder and bowel problems.

Herniated disc treatments

If your symptoms are mild or moderate, we may recommend you start with conservative treatment for a herniated disc. These measures may include:

• Cold or heat therapy
• Avoiding too much bed rest to prevent stiffness
• Over-the-counter pain medications
• Short walks and mild activity between spurts of rest

As you begin to feel better, we prompt you to gradually increase your usual daily activities in slow, controlled ways. If these measures fail to sufficiently reduce your symptoms, you may be a strong candidate for epidural steroid injections.

How steroid injections help

Epidural steroid injections help reduce pain and other symptoms of a herniated disc by going straight to the area of injury. During the procedure, we use an X-ray-guided needle that delivers pain-reducing medication and local anesthetic to the epidural space in your spine. 

This outpatient procedure usually takes about 30 minutes, during which you remain awake and relaxed in a sitting or reclining position. If needed, you may receive IV sedation for added ease. You might feel a bit of pressure, but you shouldn’t feel any pain. 

Afterward, you might need to rest for a short while, but by the next day, you can resume your usual activities with fewer herniated disc symptoms.

To learn more about steroid injections and get support from our pain management specialists at Michigan Neurology Associates, call one of our three locations or send us a message through this website.  

Our Detroit metro offices are located in Clinton Township, St. Clair Shores, and Utica, Michigan. During the pandemic, we’re also offering telehealth and phone appointments.

Spinal Injections for Back Pain

Spinal injections are among the most popular treatments for back pain. They can provide the type of relief that lasts for days or even months, giving those who suffer from significant back problems the freedom to lead their lives without the specter of back pain hanging over them. Before you seek out these injections, though, it’s important that you understand what they are and how they can work for you.

What Are Spinal Injections?

There are several different spinal injections available for individuals, each of which have their own unique benefits. These spinal injections are usually part of a two-pronged system, used both for the diagnosis of specific back issues and also for the treatment of those same issues. They are rarely the only type of treatment used, but they do tend to bring immediate relief to patients who might be in desperate need of it. When combined with a physical rehabilitation regimen, they can provide a long-term solution for back or neck pain. From spinal injections for degenerative disc disease to injections to treat sciatica, they can play a significant role in increasing an individual’s quality of life.

Types of Spinal Injections

The various types of spinal injections discussed below are used to treat specific conditions, to diagnose certain types of spinal injuries or damage, and to help both doctors and patients get a better handle on back health. These treatment options include epidural spinal steroid injections for back and neck pain, selective nerve root blocks, facet joint injections, and sacroiliac joint injections. Each of these injections differ in the type of pain they are used to treat and the location in which the injection is made, but they all work to relieve the pain of those who might otherwise have few options to relieve their suffering.  

Epidural Spinal Steroid Injections for Back Pain

Epidural spinal injections for back pain are common outpatient procedures. They take place exactly where the name of the procedure indicates – in the epidural space. This space is in proximity to spinal discs and nerve roots, and using injections in the area makes for an ideal way to treat a variety of different types of pain. Individuals who make use of this type of injection tend to suffer from nerve pain, which can express itself not only in the upper and lower back but also in the neck. 

The various types of epidural injections help to treat specific causes of nerve pain and also help to deal with pain in specific parts of the back and neck. Some of these injections are used as diagnostic tools on the part of the physicians who treat the patient, while others are used simply as tools to help bring pain relief. Each, however, is valuable in its own right.

Lumbar epidural steroid injection

This type of epidural injection takes place in the lower back. This region, called the lumbar region, can often be the site of pinched or compressed nerves. The injection is given in the epidural space in order to reach the nerve canal, the region of the back that is the location of the pinched nerve in question. The procedure for the injection does tend to be brief and it is guided by advanced X-Ray imaging called fluoroscopy, as are all spinal injections. In this case, the injection is used to treat pain in either the leg or the lower back.

Lumbar transforaminal epidural steroid injection

As you might be able to tell from the name, this type of injection takes place in the same general part of the back as above. Instead of simply going into the nerve canal, though, the shot goes to an opening on the side of the spine known as the foramen. Using this location allows for the injection of a steroid close to the nerve root, which can help to reduce swelling in this area and bring relatively long-term relief when properly paired with exercise and therapy.

The lumbar transforaminal epidural steroid injection is usually used to treat both general back pain and lower back pain. In many cases, this is also the type of injection that is used to treat pain from sciatica. The treatment might involve a needle, but it is fairly revolutionary when compared to some of the older treatments that were used to deal with these issues. It only takes a few days for the steroids used here to start working, and the end result is far lower risk than those of some of the earlier invasive options.

Caudal epidural steroid injection

This type of spinal injection is given at the bottom of the back, given near the coccyx (tailbone). Like the other types of epidural steroid injections, the target is the spinal nerves. In this case, the needle is used to access an area known as the sacral hiatus that is above the coccyx, and the steroid is injected directly into the pinched nerves near the very lowest part of the spinal canal.

The pain that is targeted in this case tends to be in the lower back, though it can also be administered to deal with chronic pain in the legs. Chronic tends to be the active word here, as the injection is almost always used to deal with chronic pain in either of the areas. It typically takes a few days for the steroid to work to reduce pain in either location, though there is usually some immediate relief due to the numbing agent used during the procedure.

Cervical epidural steroid injection

This type of injection is not actually given in the back, but rather in the neck. During the procedure, the needle will be used to access the epidural space, with fluoroscopic guidance. The steroid here will be used to reduce inflammation and to provide relief for the patient, allowing improved pain level, activity and function.  

This type of injection is used to treat pain in the shoulders, neck, and arms that tend to be caused by either a compressed nerve or multiple compressed nerves in the upper spine. The pain here can actually come from issues like herniated discs or from spinal stenosis, and providing relief for the pain can be a life-changing process. As with the other types of injections, there is a waiting period between the injection itself and pain relief – generally up to a week, as the steroid goes to work reducing inflammation. 

Thoracic epidural steroid injection

Rather than targeting the spine at the lower back or up towards the neck, this is more of a mid-back injection. It’s generally the same type of procedure as you’d see in any of the others listed above, but with the more specific target of the nerves that impact your thoracic region. The causes of the pain in this region are especially varied, ranging from disc herniation and injury to spinal stenosis and certain problems that occur after spinal surgery.

This is another type of injection that is not necessarily used to treat back pain. While it can be used to deal with general upper back pain, it has a tendency to be used to treat pain in the flank and the abdomen. As with the other types of injections, you’ll largely look to see an improvement in your condition after a few days, though you may receive some immediate relief simply due to the use of the local anesthetic.

Selective Nerve Root Block

A selective nerve root block can be both diagnostic and therapeutic. Though it can be used as a form of treatment for nerve pain in the arm or leg, it is the procedure’s utility as a diagnostic tool that tends to be the most valued. This is a fairly advanced procedure as compared to the epidural procedures listed above, as the diagnostic response to the procedure can be used to help isolate a specific root cause of the pain, and guide a spine surgeon to a specific target point for minimally invasive spine surgery.

Nerve block injection in spine tends to be very precise and diagnostic because they take place directly next to the nerve root itself, which can be the underlying source of the pain. This type of injection can also be a good alternative to epidural steroid injection when a single nerve root is suspected to be the underlying pain generator, or when epidural steroid injection has not resolved the pain in the past.

Facet joint injection

The facet joints are joints that lie on both sides of the spine. As you might imagine from the name of this particular injection, facet joint injections are made in these joints. These injections are often used for individuals who experience long-term back pain, especially when that pain occurs after some type of back injury or with age related degeneration. In many cases, this type of injection is not only a method of treatment but also a method of diagnosis when trying to determine the cause of the pain.

A facet joint injection can be a good choice for many patients who are still in the process of determining why they have back problems. Because the numbing agent itself can help to quickly and easily provide at least an initial diagnosis, the procedure is one of the few diagnostic methods that can also provide immediate relief for an individual. The longer-term, but still transient, relief that is provided by the steroid is also a good way to help an individual who might otherwise be suffering from an undiagnosed type of back pain.

In common diagnostic procedures, a medial branch nerve block is performed, targeting the individual sensory nerve that senses pain is a given joint or sets of joints in the spine. If there is temporary relief with this set of injections, the diagnosis of facet joint pain is made, and the lasting treatment recommended is radiofrequency ablation of the sensory nerve. This treatment can relieve spinal joint pain for 6 months to up to 18 months.

Sacroiliac Joint Injection

The sacroiliac joint injection is a fairly common type of injection that is used to treat low back and hip pain. As the name would suggest, this injection is given in the joint that connects the sacrum to the hip. These joins lie close to the spine and represent an ideal area for this type of injection. Though it has quite a bit in common with several other types of injections, this method does have fairly specific uses. 

This type of injection has three different uses for back pain. One of the most common is for the treatment of lower back pain, but the injection itself can also be used as a tool to diagnose the cause of such pain. Sacroiliac joint injections are fairly common procedures for those who receive treatment for chronic lower back pain, especially when they reach the point where their pain begins to interfere in their daily lives.  

The sacroiliac joint injection tends to be effective in two different ways. The first, and the most immediate, is due to the local anesthetic used in the procedure. This provides an immediate, albeit temporary, form of relief to the patient. While this does wear off quickly, the second element of the injection tends to provide much more lasting relief. Like many other injections, the use of a steroid here helps to reduce inflammation and allows for a great deal of pain relief after a few days. As such, it is considered to be a solid alternative for some individuals who experience both chronic and acute back pain.

Stem Cell Therapies for Back and Neck Pain

Regenerative medicine and stem cell therapies are the cutting edge when it comes to dealing with low back and neck pain, as well as joint pain and musculoskeletal conditions. These treatments are still emerging and being evaluated in many areas, and should be considered experimental, as they are not yet FDA approved. When utilized for the proper p

Stem cells are undifferentiated cells that haven’t yet been put to a specific purpose. They may become another type of cell in the future, but in their current state they merely have potential. This, combined with their ability to repair other cells, gives them the potential to repair other damaged part of the body and take on an important role in pain management.

Two types of regenerative medicine therapy offered are amniotic tissue therapy and placental tissue matrix therapy. These products are derived from healthy donors at the time of birth, without harming the mother or baby. They are medically sterilized and “immune-privileged”, meaning they do not produce an immunologic rejection response. When injected into the targeted area at the root cause of a painful condition, these tissues, biologic proteins and growth factors have healing properties that help regenerate tissue, improving pain over the long term. Stem cell therapies have a great deal of potential when it comes to dealing with issues like herniated discs or as spinal injections for degenerative disease, but at present should be considered in only limited conditions and patients, and are new, emerging treatments considered “off label” by the FDA. While research is still ongoing, it does seem safe to say that this type of procedure will have a huge impact on future treatments. 

What if Spinal Injections Don’t Work?

In some cases, getting epidural spinal injections for back pain might not help. Spinal injections for degenerative disc disease might not be for you, for example, and you’ll need to look at alternatives. Choosing the right pain management options is important, and getting injections isn’t your own choice. You may benefit more from therapy, for example, or from regenerative techniques that can help you to better combat the root causes of your back problems. No matter what your choice, it’s important that you work with professionals like the ones here at Pinnacle Pain & Spine to help ensure that you find an adequate way to deal with both your back issues and the impact that back pain has on your life.

The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment

Background and aim:

The aim of this retrospective study was to investigate the therapeutic effect of transforaminal epidural steroid injection in patients with chronic low back pain and radicular leg pain due to lumbar disc herniation.

Materials and methods:

This study included 80 patients (32 female and 48 male; mean age: 45.8 years [range: 25-65 years]) that received fluoroscopically guided transforaminal epidural steroid injections for chronic radicular low back pain due to lumbar disc herniation. All of the patients had diagnostic MRI findings and did not respond to conservative treatment. All injections were performed by the same physician at the interventional pain unit of a tertiary hospital. The effectiveness of transforaminal epidural steroid injections was assessed via a standardized telephone questionnaire administered 2 years after the first injection.

Results:

Mean duration of radicular low back pain was 24.50 ± 18.25 months. Most of the epidural injections were administered at the L5 and S1 levels. The most effective post-injection period was the first 5.11 ± 3.07 months. Mean duration of injection effect was 12.46 ± 7.24 months. The response rate to the epidural steroid injections was 72%.

Conclusions:

There was negative correlation between the duration of treatment effect and the duration of pre-treatment symptoms. Additionally, clinical improvement of radicular low back pain increased significantly as the duration of pre-treatment symptoms decreased. Based on the present findings, we think that transforaminal epidural steroid injections can be used as an alternative treatment for managing chronic radicular low back pain.

Keywords:

Low back pain; epidural steroids; radiculopathy; transforaminal.

There Are 3 Types of Epidurals: Which One is Right for You?: Advanced Spine and Pain: Orthopedic Specialists

Whether you suffer from pain related to a chronic condition like arthritis or a sudden sports injury or fall, sometimes conservative treatments like pain relievers and hot and cold packs simply don’t provide the relief you need. 

The Advanced Spine and Pain team specializes in both immediate pain relief and long-term pain management. Dr. Randy Davis, Dr. Brain Lee, Dr. Thomas Raley, and Dr. Alfred Correa value innovative treatments and are constantly on the lookout for proven, safe treatments that pick up where traditional ones leave off. 

One that we rely on consistently is epidural steroid injections, which we deliver directly to your area of pain. 

Our patients know that we never settle for anything but the most effective, personalized treatment route, and we work until we find the pain solutions that are right for you. 

What’s great about epidural steroid injections

If you’re at the point where you need an epidural steroid injection, you’ve likely tried other treatments to ease your pain, including medication or physical therapy. These injections work by delivering steroid anti-inflammatory medications along with local anesthetic to stressed nerves.

Epidural treatment is especially helpful for the types of pain that plague many people: a variety of back problems, from sciatica (which causes lower back pain) and degenerative disc disease pain to spinal stenosis, herniated discs, and radiculitis. It’s also effective at relieving neck pain, and even leg pain. 

In addition to the much-needed pain relief you feel quickly after the shot, epidural steroid injections can help you avoid surgery.

Types of epidural steroid injections and who they help 

The three most frequently used types of epidural treatments treat pain in different locations of the body:

1. Transforaminal epidural steroid injection

This epidural steroid injection is administered by inserting the needle between your spine and spinal cord, or the vicinity of where your spinal nerve exits your spine. When a nerve root in this area becomes inflamed and irritated, you feel pain that starts in your back and extends down the leg.

The transforaminal injection is particularly helpful in treating sciatica and a host of other back problems. 

2. Caudal epidural steroid injection 

We give you this shot if your pain is focused at the base of your spine. We insert the needle below the lumbar spine, or the lower back. These injections can help with back problems such as herniated discs and leg pain from sciatica.

3. Interlaminar epidural steroid injection 

These shots can be given anywhere on the spine and are particularly effective when treating back, leg, neck, and arm pain. 

After thoroughly evaluating your medical history and chronicling your pain, we recommend the type of epidural steroid shot he thinks matches your needs best. If the thought of an epidural steroid injection of any sort makes you uncomfortable because you simply don’t like needles, rest assured the process is brief and painless. 

When you come to Advanced Spine and Pain for an epidural steroid shot, we make you as comfortable as possible. First, we give you a local anesthetic at your injection site so you feel nothing during the procedure. Getting the injection takes only 10-15 minutes on average, but if your condition and pain are more severe, you may get more than one. 

After your injection, we observe you for about half-an-hour to ensure that you don’t have any reaction, and then you’re on your way. If you have any tenderness, an ice pack does the trick. 

It’s also important to know that it’s normal to experience a bit more pain directly after getting the injection and a few days afterwards. You also might feel immediate relief, though improvement often continues for the next two to four days. Best of all, the relief your injection provides keeps you pain-free for a number of months. 

Epidural steroid injections can be used in concert with other pain-relief approaches, or they might be your primary treatment. Our patients’ feedback is consistently positive about epidural steroid injections, and most of the time, these shots are more than worth it, especially if other approaches have failed.

Call the Advanced Spine and Pain office that’s most convenient for you to schedule an epidural steroid injection consultation today, or reach out to us through our website.  

Spinal Injections and Nerve Blocks Treat Neck and Back Pain

Spinal injections, also referred to as spinal blocks, is the administration of a medicine directly into a specific area of the spine. They can be used to treat a variety of conditions that affect the spine anywhere from the upper cervical spine to the sacrum.

Injection treatments can help diagnose and relieve neck or back pain that may radiate into the patient’s arms and legs (eg, cervical radiculopathy, lumbar radiculopathy). A spinal injection for diagnostic or treatment purposes may be included as part of your multidisciplinary treatment plan that could include medication and physical therapy.

Spinal injections require precise placement of the needle using x-ray guidance; the close proximity of key nerve structures is seen in this anatomical illustration of an axial lumbar level. Photo Source: 123RF.com.

Q1. What type of medication is in the spinal injection?

The spinal injection is usually comprised of either a local anesthetic alone, steroid alone, or a combination of a local anesthetic and steroid. Another name for steroid is corticosteroid; a powerful anti-inflammatory medication. Sometimes a contrast medium (x-ray dye) is added to the injection mixture to help guide accurate placement of the needle using image guidance.

Q2. What types of spinal disorders may benefit from an injection?

There are a wide range of spinal disorders that may benefit from an injection. The decision to proceed with an injection is based on a variety of factors and should be made after consultation with a physician. Most physicians recommend a period of conservative treatment, usually 4-6 weeks, prior to recommending an injection as many cases of neck or back pain will improve within that time frame.

• Common conditions where an injection might be appropriate, include spinal stenosis, disc herniation, failed back syndrome, sciatica, facet joint pain, and sacroiliac joint pain.
• A 2020 study in Journal of Bone and Joint Surgery suggests epidural steroid injections are NOT effective for degenerative spondylolisthesis, a condition where one of your vertebrae slips out of place and presses on the nerve roots below it. According to the study, the injections were ineffective both in people who had surgery and who didn’t have surgery. 

Q3. What is the difference between a spinal injection and nerve block?

Spinal injections are a broad term that refer to any type of injection that involves the spine. Nerve blocks are a subtype of spinal injections that target a specific nerve. When the medicine is injected onto the target nerve, it can “block” the transmission of pain signals that travel from the pain generator (eg, lumbar herniated disc) to the brain.

• In summary, all nerve blocks are spinal injections, but not all spinal injections are nerve blocks.

Q4. What are the different types of spinal injections?

Epidural Injection
The prefix “epi” is Greek for “upon” or “on.” The dura is the outermost layer of a three-layer soft tissue sac that encloses the spinal cord and cauda equina. Therefore, an epidural injection refers to an injection of medicine onto the dura.

There are 3 types of epidural injections. They are named based on the approach the needle takes to get to the dura.

• Caudal epidural injection: The spinal canal terminates through an opening at the end of the sacrum called the spinal hiatus. The medicine is injected into the epidural space via the sacral hiatus. This is the same approach that is used to provide anesthesia to pregnant women during labor.

• Transforaminal epidural injection: Nerve roots exit the spinal canal at each spinal level through a bony opening in the spine called the neural or intervertebral foramen or neuroforamen. The medicine is injected into the epidural space via these foramen.

• Interlaminar epidural injection: The lamina is a section of bone that forms the posterior arch of each vertebral level and together form the spinal canal. Like shingles on a house, the lamina from the vertebral level above, lays on top of the lamina immediately below it. The tip of needle enters in between the lamina to allow delivery of the medicine into the epidural space.

Selective Nerve Root Block(SNRB)/injection
SNRB’s involve injection of a local anesthetic onto a specific nerve root. They are typically used in a diagnostic manner. In patients with multiple areas of spinal compression, SNRBs—in conjunction with the patient’s history, physical exam, and MRI—can help identify to identify the pain generator (eg, spinal stenosis).

Medial Branch Block (MBB)/Injection
The facet joints are a pair of bony projections that connect a vertebral level to the vertebral level directly above and below it. Like any joint in the body, it can become arthritic over time and is responsible for some forms of back pain. An MBB is an injection of local anesthetic onto the medial branch nerves; the nerves that transmit pain signals from a facet joint. They can help determine whether the facet joint is the pain generator.

Painful facet joints may be treated using a nerve block that stops the joint’s medial nerve from transmitting pain signals. Photo Source: Shutterstock.com.

Facet Joint Injection
Facet joint injections are injections directly in the facet joint itself, similar to injecting anti-inflammatory and/or pain-relieving medication(s) into an arthritic knee.

Sacroiliac Joint Injection
There are 2 sacroiliac joints. They help connect either side of the sacrum to the ilium; a part of the hip joint. They are the link from the axial skeleton (eg, skull, vertebral column) to the rest of the body and, like most joints, can become painful in certain cases. A sacroiliac joint injection is an injection directly into one or both of the sacroiliac joints.

Q5. What medical specialists perform spinal injections and nerve blocks?

Injections are technically demanding procedures that should only be performed by physicians trained specifically in spinal injections. In most cases, injections are usually performed by an anesthesiologist, radiologist, physiatrist, orthopaedic surgeon, neurosurgeon, or neurologists.

Q6. What is the role of these procedures in the treatment of neck and back pain?

There are three reasons why an injection might be used:

1. Help identify the pain generator (diagnostic)
2. Provide pain relief (therapeutic)
3. Predict the relief the patient might expect from a subsequent intervention—a more invasive procedure such as nerve ablation (prognostic).

Q7. How often can I have a nerve block or spinal injection?

A maximum of 6 injections in a 1-year period is recommended. There is no evidence to support a series of 3 injections. The decision to have a second injection should be based on the effect of the first injection.

Q8. What are the potential benefits of these injection procedures?

The primary benefit of spinal injection is to provide relief of pain and disability.

Q9. What are the potential risks of these spinal injection procedures?

Spinal injections are typically well tolerated and safe with an extremely low rate of complications. The most common risks include small amounts of bleeding, headache, and facial flushing. More major complications include puncture of the dura, infection, and nerve damage. These major complications occur in less than 1% of people undergoing spine injections. People with diabetes may note a temporary elevation of their blood sugars.

Q10. Typically, how long do the effects of injection treatment last?

It is difficult to predict how long an injection will last given the many variables at play—such as the type of injection, type of pathology (eg, diagnosis, cause), and/or how long symptoms last. Most people can expect to receive 1.5 to 3 months of pain relief. In some cases, an injection may provide minimal or only a few days of pain relief, while other patients may see symptom improvement up to a year after receiving an injection.

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90,000 What is a rear convex disc?

A posterior bulging disc, also known as a herniated disc, occurs when the spinal disc that sits between the vertebrae bulges out due to compression. This condition can be painful and can ultimately restrict the patient’s mobility. A posterior convex disc arises at the back of the spine opposite the stomach, and this is often the result of forward bending. People who do heavy heavy work are more likely to experience this type of condition, and treatment can vary depending on the severity of the injury.

In some cases, a person with a posterior convex disc may not experience any symptoms at all and may not be aware that the disc is convex.The disc will recover itself in this situation and will not require medical attention. More severe cases of posterior disc protrusion can also heal on their own with enough time and rest, although more serious cases usually require medical attention in the form of physical therapy, spinal decompression, or even surgery. Surgery is usually the last resort for these injuries, as the process can be invasive and may not prevent future bulging discs.Nerve damage is another risk because the disc is so close to the spinal cord and associated nerves.

The spinal disc is a soft membrane filled with a gel-like liquid. When the spine contracts or begins to work abnormally, this vertebral disc can begin to press outward from the vertebrae, which essentially crush it. This can rupture the disc, which is a more serious condition that must be surgically removed.A posterior bulging disc that has not ruptured can still lead to pain and limited mobility, especially if the disc begins to press on the nerve.

Doctors usually reserve surgery for posterior convex disc injuries that lead to neurological problems. When a disc presses on a nerve, the part of the body served by that nerve can be damaged. The person may experience pain, numbness, tingling, or even loss of mobility. This is considered a more serious problem, especially if the patient loses mobility or feeling in the affected area.Surgery will be used to relieve pressure on the nerves, but the success rate of surgery can vary. In some cases, patients may still experience neurological symptoms even after successful surgery.

OTHER LANGUAGES

90,000 Jixer. How many in this word …

The formidable nickname “jikser” by its coolness and brutality (moreover, justified) has firmly entrenched itself on the first lines of the hit parade of motorcycle words, plunging people in the subject into awe and ecstasy.Only the phrase “liter jikser” is cooler.

Suzuki has always had its own vision of motorcycle production, especially sportbikes – every GSX – R is designed to be the very best sports bike of its time. The G SX – R 1000 family confirms this once again. “Liter” in the model line, which by that time already had five different engine sizes (250, 400, 600, 750, 1100) appeared later than everyone else and immediately made a rustle in the camp of competitors.

First generation (2001-2002 K 1- K 2)

In 2001, the first generation Suzuki GSX was launched – the R 1000 K 1 – the starting point for future championship sportbikes. Index K 1, 2, 3, 4 . .. etc. denotes the model year of a particular motorcycle, the starting point is 2001. The newcomer immediately received the title of “motorcycle of the year” in the ratings of 13 reputable motorcycle publications around the world.

Taking the GSX – R 1100 and GSX – R 750 as a basis, the engineers did a great job, the result of which was a new engine, not made from scratch (but, nevertheless, fraught with unprecedented aggression and technology), and a reconfigured chassis part.750 cubic centimeters turned into 998 by increasing the bore by 1 mm and the piston stroke by 13 mm, the pistons themselves are ultra-light forged low friction (minus 3 grams of each weight compared to the GSX – R 750). The clutch basket, gear ratios of the gearbox, and the oil cooling system have changed. The cylinder walls are covered with a nickel-phosphorus-silicon-carbon composite instead of liners, hollow camshafts, four-valve cylinder heads, a balancer shaft. A big step forward is the clever dual-flap-per-cylinder fuel injection system that mimics the operation of a constant vacuum carburetor. The competitiveness of the Yamaha YZF – R 1 1998 became a big question, it turned out to be less powerful and heavier.

GSX – R 1000 K 1 is like two drops of water similar to the GSX – R 750 model 2000-2001. Motorcycles really have a lot in common, the differences are concentrated in the nodes that take on the increased load – the “liter” frame has a 10% increase in torsional rigidity (due to the thickening of the walls by 0.5 mm), the engine has grown in volume by 15 mm higher and 6 mm longer, the wheelbase is completely identical, the length, width and offset are approximately the same.

As a result of all the transformations, the new king of racing tracks turned out to be surprisingly lean to the envy of competitors – 4.5 kg heavier than the 2001 Suzuki GSX – R 750. and 1 kg heavier than the 2000 Yamaha YZF – R 6.

The 4-2-1 exhaust system is unique in its own way – to reduce weight, its elements are made of a combination of titanium, steel and aluminum, and inside the Suzuki Exhaust Tuning (SET) pressure valve, which is electronically controlled. Its main task is to regulate back pressure. At low revs, the valve is closed, which allows for more torque and less noise.

They did not spare money for a good running gear: a steering damper, a 43 mm “flip” in front and a monoshock at the rear with a full range of adjustments. It is worth noting that professionals note some “stubbornness” when putting the motorcycle into turns. For effective braking, massive floating six-piston calipers at the front and two-piston at the rear are responsible, the front brake discs are huge – 320 mm.

In 2002, there were no cardinal changes aimed at improving the overall balance of the structure – mirrors, luggage hooks were “upgraded”, and new colors appeared. All together did not affect the weight of the motorcycle. It is not difficult to distinguish K 2 from K 1, the last knee of the exhaust system, preceding the muffler can, is painted black, and the middle part (with the Exup valve) is made of titanium.

Due to its friendliness and relative comfort for the pilot (in comparison with all subsequent generations) K 1 and K 2 are frequent guests on the secondary market, spare parts and tuning parts are on sale in large quantities. First generation motorcycles are reasonably respected by stunt riders for their indestructibility and maintainability.

Second generation (2003-2004 K 3- K 4)

In 2003, Suzuki refined its flagship sportbike to be lighter, faster, more powerful and more responsive. Dry numbers (minus 2 kilograms of weight and plus 2 horsepower) do not fully reflect the nature of the changes made.

It was decided not to touch the displacement of the engine yet, the improvement of power indicators, torque and speed of response to turning the throttle handle is the result of painstaking tuning and application of the latest technologies.Due to the introduction of additional ventilation windows between adjacent cylinders, it was possible to reduce the loss for compression of air under the pistons; it now flows from the high pressure zone to the low pressure zone. The power of the engine management system has been increased from 16 to 32 bits. Each cylinder has two maps for changing the ignition timing (one at low load, the other at maximum). The transformations brought an additional 2 liters. with. and 10 Nm.

Owners of K 1 and K 2 often complained about the explosive and uncontrollable reaction of the engine to the throttle handle, to which the Japanese responded by installing the Suzuki Dual Throttle Valve (SDTV) system (two throttle valves, one of which reacts to the pilot’s actions, the other – CPU) – thus the wayward character was curbed.

With a significantly redesigned frame (structural elements are connected using extrusion, ribs with “programmed” stiffness, painted black), the geometry of the motorcycle has not changed, the length and width are identical to the motorcycle of the previous generation. Additional changes include a redesigned bolt-on rear subframe and an adjustable rear swingarm mount that allows chassis geometry changes.

Suzuki, under the pretext of reducing the total weight, decided to abandon the six-piston floating front calipers in favor of four-piston radial mountings and a reduced diameter of the front brake discs from 320 mm to 300 mm. The main reason is the saved 300 grams of weight.

The appearance of the K 3 is optimized for the sake of improving aerodynamics and weight distribution – the vertically positioned headlight made it possible to narrow the head plastic and place the inertial pressurization pipes closer to the centerline (in this place the highest air flow pressure), the taillight was equipped with LEDs, the lightweight titanium exhaust system saved 600 grams of weight, the dashboard received a blinker.To provide the driver with more freedom while driving the motorcycle, the gas tank was narrowed in the seat area.

In 2004, a couple of innovations settled in the design of the GSX – R 1000 K 4, which became the standard for all subsequent generations – now instead of the “Suzuki” inscription on the gas tank, there is a changed company logo in the form of a convex S letter, and the brake calipers, with external similarity, have become two-pad ( four small pads for each caliper).

Multiple paint colors have been added from the previous year, including the Mat Mladin Championship Replica Edition.

An interesting fact: the first two generations, despite all their merits and regalia, were distinguished by very mediocre control, in order to sharply change the trajectory of movement at a decent speed, it was necessary to have remarkable physical strength. The K3-K4 ran out of truly indestructible liter “jixers”.

Third generation (2005-2006 K 5- K 6)

The main focus in the development of the next generation is the modernization of the chassis and engine.The list of innovations is significant – a redesigned cylinder head, an increased cylinder diameter, intake and exhaust valves are now made of titanium alloy (intake valves have increased in diameter), even lighter pistons, an increased compression ratio, thinner connecting rods and crankshaft, similar gear ratios , the reconfigured Suzuki Dual Throttle Valve System, the fuel injection system improved again – starting with the K5, they began to put two injectors per cylinder, the throttle valves were increased from 42 mm to 44 mm, a reverse torque damper appeared in the clutch basket (to reduce engine braking when the “Gas”), in addition, we went through an audit of the exhaust system again. Many noted that the K 5 stands out nicely from the rest of the variants with its good mid-range traction. The result of the activities of the engineers resulted in a weight reduction of 2 kg, an increase in the volume of the combustion chamber and an increase in power.

K 5 and K 6 have decreased in almost all geometric dimensions compared to previous generations and began to stubbornly resemble the GSX – R 600 in the chassis (the entire chassis was updated – wheels, frame, suspension). Dzhikserovody, switching to third-generation motorcycles, all as one noted a closer and less relaxed sitting at the wheel.See for yourself – the distance from the seat to the handlebars has been reduced (mainly due to the shorter gas tank), the driver’s pegs have been lowered together with a 20 mm lowering of the saddle height.

Cosmetic changes are visible to the naked eye, it is not so easy to confuse K 5 with K 1 or K 3. The air ducts of the inertial boost system, separated into a separate section, now compress the headlight even more, which has become narrower and in shape resembles a bird with spread wings. The side plastic is losing ground and generation after generation loses in size and thickness. The tail unit from a long “shovel” has turned into a complex polygon with a lot of edges. Direction indicators have moved once and for all into the rear-view mirrors. There was not much room for a passenger on “jikser” before, but now it is not easy to select the one whose backside matches the size of the passenger cushion!

The frame of the motorcycle was re-profiled in such a way as to concentrate the center of mass as low and close to the centerline as possible, therefore it became slightly less resistant to impacts.There is a certain series of VIN numbers that are prone to cracking along the seam, Suzuki even released a reinforcement kit to take some of the stress off the frame. The lightweight rear swingarm is designed to allow maximum exhaust pipe retraction and thereby improve mass centralization. The braking system also did not go unnoticed – the front discs increased to 310 mm, a radial brake cylinder with a 19 mm piston settled on the steering wheel.

In the second year of production, the third generation of the Suzuki GSX – R 1000 has traditionally limited itself to updating the motorcycle livery.

Fourth generation (2007-2008 K 7- K 8)

The fourth reincarnation of the legendary “jikser”, having added great power, added centimeters in length, width and wheelbase and gained 6 kilograms of excess weight.

The appearance did not change so dramatically, the engineers did not deviate from the general concept. There is even less side plastic left, the headlight parted with sweeping fenders, in contrast to this, two monstrous exhaust pipes opened up on the sides, which only the lazy did not groan.The manufacturer explains this move by stricter environmental standards and better weight distribution of the device.

A lot of work has been done on the engine again – the fuel injection system has been reconfigured, the ventilation holes between the cylinders have increased to 48 mm, but the main innovation is the updated engine management system, which, in addition to allowing an increase in power, also has three switchable modes. As an experiment, a hydraulic clutch was installed in place of a mechanical clutch drive.Conceptually, the architecture of the K 1-K 8 engines is similar, many parts are interchangeable.

The frame and subframe were once again lightened and strengthened (the location of the seams was changed, and a gusset was added under the vertical seam near the steering column), the updated front fork now provides the wheel with 125 mm of travel, and the new electronically controlled damper improved the directional stability of the motorcycle. The bike lost the excessive nimbleness of the K 5 and gained the necessary stability on the trajectory.Starting with the K 7 and all subsequent generations, a single-piston caliper was installed at the rear.

There are black spots in the Suzuki GSX biography – R 1000 K 7. The idle sensor was sick from birth, so it worked every other time, as a result, the motorcycle sometimes started at high revs, the problem was solved by a global recall campaign.

Suzuki GSX – R 1000 K 8 again differs from the prototype only in the coloring.

Interesting facts: up to the fourth generation inclusive, the main part of criticism from owners relates to the braking system – aluminum pistons in the calipers quickly overheat and lose efficiency.A common solution to the problem is to install Yamaha YZF calipers – R 1.

Fifth generation (2009–2011 K 9- K 11)

By 2009, the developers have prepared a motorcycle with significant changes in appearance and filling.

That there is a flashy appearance with sharp cheekbones and a winged headlight that has taken its place again. The serious torso is supported by equally impressive exhaust pipes (even more massive, which will not be reflected in the best way in case of falls).The engineers built an even more resourceful engine almost from scratch, hoisted it all on an inverted telescopic BPF fork (big piston fork) and equipped it with new monoblock brakes, the expected ABS and traction control motorcycle did not see.

A new engine, oddly enough. develops exactly the same power as before. The clutch is again mechanical, according to the manufacturer, such a drive is still preferable in racing conditions, it is lighter and more accurate.By inheritance from the K 7, the engine power mode switching unit was dropped (now it is located on the left clip).

When designing the chassis, the task was to combine the good handling of the K 5 and the stability of the K 7. To do this, the rear swingarm had to be lengthened, but at the same time the wheelbase had to be reduced to 1405 mm. The front fork with enlarged pistons, coupled with updated monoblock front calipers with a modified diameter of the main brake cylinder (from 19 mm to 17.5 mm) work effectively in a pair, but the braking dynamics should be recognized as still not corresponding to the engine’s potential.

Sixth generation (2012-2013 K 12- K 13)

Hopes that in 2012 will see the light of a completely new revolutionary “jikser” were not destined to come true. Suzuki GSX – R 1000 K 12 was just a bug fix.

New 11% lighter pistons and an increase in compression ratio to 12.9 resulted in an increase in power at medium revs, which in turn slightly improved acceleration and fuel efficiency.The bike’s weight is reduced by 2 kilograms as a result of the abandonment of two exhaust pipes in favor of one, as well as the installation of thinner brake discs, a shortened front fork and a lighter front tire. Brembo monobloc brake calipers are a royal gift to brand lovers.

Stylistic changes with the exception of the exhaust pipe are few – new graphics, red stripes on the plastic and wheels.

Conclusion

The

Jixer has been and remains an icon of style and power among fanatical speed enthusiasts.Even having been delayed in development and letting the more nimble “Europeans” go ahead, he is still the personification of risk, courage and recklessness.

Fuse> 27 April 2013 13:51 Mikhail Pimus
VIN 90,000 – Page 4 – Cayenne Club

M-numbers
Description of the car
Vehicle Identification Number (VIN) WP1ZZZ9PZ9LA82688
Order type 9PAAI1 Cayenne Turbo
Model Year 2009 90 150
Lock code
Lock date
Engine type M4851
engine number
6
Transmission type A4852
transmission serial number JG304232
Tire code 5V2B
General data
Invoice date 1 2008-10-30
Invoice date 2
Number of Z requests 0 90 150
Regional equipment C38 Russia
Sales partner 3,620,000
Commission number 9PZ217
Body data
Body paint LM8W
Outer color 9S9S
Exterior color Light brown metallic (Macadamia) / Light brown metallic (Macadamia)
Interior equipment data
Salon equipment NS
Interior equipment Leather interior Havanna / Sand Beige, smooth-finish leather
Interior material code LED Genuine leather
Seat combination number PCA
Middle seat material LED Genuine leather
Side bolsters material LED Genuine leather
Backrest material KL Imitation leather 90 150
Mat color code 7K3
Electrical / Electronic Data
serial number DME 070082750343
Motronic CVN 0282CEC2
transfer case serial number LD003569
PCM control unit (main unit) number 7L5035884D
Serial number of the PCM control unit (main unit) BE085027333
PCM software version, card (depending on vehicle delivery) 7L5919193F
PCM control unit (main unit) software version 0108163B
Hardware version of the PCM control unit (main unit) 01020727
Warranty data
from to date of the agreement Coverage scope Assistance Mileage limit Warranty for a specific market Valid for the market 90 150
New car warranty 12. Feb 2009 13 Feb 2011 no – km no 90 150
LPC warranty Feb 13, 2011 Feb 13, 2012 – km no 90 150
Long Term Warranty Feb 13, 2012 Feb 13, 2019 – km no 90 150
Warranty for used cars (1) Nov 30, 2014 Nov 29, 2015 Nov 30, 2014 full coverage – km no 90 150
Warranty for used cars (2) Nov 30, 2015 Nov 29, 2016 Nov 27, 2015 full coverage no – km no 90 150
Operations
Designation Volume Status Stop sales 90 150
WA06 PROG. AIRBAG CONTROL 1 1 no 90 150
WA24 PCM3 SOFTWARE UPDATE.0 1 1 no 90 150
WB09 High pressure fuel pump Cayenne Turbo 1 1 no 90 150
W911 SUPPLY UNIT 1 no
M numbers PageTop
MNR Type Description
1G4 SPARE WHEEL, ECONOMY. 19”
SEATS
1N3 DEPENDENCE. FROM SPEED WILL STRENGTHEN. STEERING. CONTROL
2D1 SPORT DESIGN PACKAGE (AEROKIT)
3FU LARGE DOOR SYSTEM PORSCHE
3J7 FRONT HEADREST WITH CREST
3X1 OPENING. FOR TRANSPORTATION. LENGTH LOADS WITH SKI CASE
3Y4 SUN PROTECTION REAR BLINDSBOKOV. GLASS
4E7 REAR COVER LIFT (POWERLIFTGATE)
7D7 BUILT-IN CD / DVD CHANGER
7X8 ULTRASOUND. PARKS. ASSISTANT + REVERSE CAMERA
9ZP STATIONARY CAR TELEPHONE (D) WITH TUBE
AAD Front air intakes painted
AHA Door handle trim and center. wood consoles: light, gloss
C9N WHEEL CAYENNE SPORTPLUS 21 “(10X21)
PE3 Sports seats with parameter memory
Ph3 3-spoke multifunction steering wheel, olive wood, light (polished) 90 150
PH5 Interior trim including gear knob, light wood, gloss
PO2 Electro-comfort package (blackout + Welcome Home) in conjunction with PE1 / PE2 or PG1
QJ4 ALUMINUM ELEMENT PACKAGE, BLACKLINE, MAT.
QV1 WITH TV RECEPTION / TV TUNER

MNR Type Description 90 150 0AW V STABILIZER, ACTIVE BODY CONTROL (PDCC) 90 150 0E1 T SHORT WHEELBASE 90 150 0GU C OVERRIDGE RATE EURO 4 UNDERBRIDGE EJOBZD
T WITHOUT lABELS AND EMBLEM
0NB T SET labels in basic configuration
0P0 T STANDARD EXHAUST PIPE
0SN C lABELS / PLATING IN RUSSIAN
0TD V FRONT AND REAR PADS
0VA T without onboard DOCUMENT
0Y3 C cold zone
0YZ T WITHOUT SPEED DETECTORS, REAR AXLE 90 150 1A2 T PETROL ENGINE DIRECT INJECTION (BDE) 90 150 1BK T AIR SUSPENSION 4 CORNER CDC (PASM) 90 150 1CY T COMPARED E17P AUTO.TRACTION-SCEPN. DEVICE, OTHER COUNTRIES 90 150 1E1 T ACTIVATED CARBON ADSORBER 90 150 1EY C SPEC. FACTORY. TABLE. WITHOUT GENERAL RESOLUTION NO. (REST COUNTRIES)
1KP T REAR DISC BRAKES 18 “PLUS, RED
1L2 C AIR FILTER FOR HIGH DUST COUNTRIES
1LH T FRONT DISC BRAKES 19″ RED. COLORS (SET) 90 150 1NP F HUB CAP, COLOR EMBLEM
1PC T WHEEL MOUNTING BOLTS WITH SECRET
1Q0 T WITHOUT COMPENSATION LOADS ON STEERING WHEEL 90 150 1S1 F BOARD TOOL.AND LIFT
1SA T WITHOUT ENGINE PROTECTION
1T3 C SLEEVE. MATERIAL, AVAR SIGN STOPS 90 150 1XK F DER. STEERING. WHEEL, 3 SPOKES, (OLIVE, LIGHT) 90 150 1Y0 T WITHOUT FRONT / REAR AXLE LOCKOUT
1Z5 C INCREASED FUEL CAPACITY FOR FIRST FILLING, 26 L
2A0 T WITHOUT TRANSPORTATION
2A0 T WITHOUT TRANSPORTATION
T … ADJUSTMENT + MEMORY
2G1 T INSERT FOR CHARGING UNELEADED. PETROL 90 150 2JB T STANDARD BUMPER 90 150 2L0 T WITHOUT WINCH 90 150 2V5 T SUPPLY SUPPLYAIR WITH ACTIVIR. COAL
2WA T WITHOUT ADDITIONAL TIRE
2X2 T MANAGEMENT TIPTRONIC STEERING WHEEL
3B4 C SYSTEM FIXATION CHILD SEAT ISOFIX
3CA T unbaffled
3D8 T central console SMOOTH SKIN
3GE T raised floor TRUNK
3LH T door trim / side , WHOLE LEATHER
3M0 T WITHOUT SPECIAL EVENTS
3ME T VELOR COVERED FLOOR WITH WASHING VORSOM, ON PROTECT. SILL
3NW T REAR SEAT / BACKREST, DIVIDED, FOLD.
3PN T EL.SET EMAIL, LONG MEMORY
3W4 T STANDARD SPEAKER PACKAGE
4A4 T HEATED SEATS FRONT / REAR DEPARTMENT. REGULATION
4D0 T WITHOUT SEAT VENTILATION / MASSAGE SEATS
4GF T WINDSHIELD WITH HEAT PROTECTION
4h4 T CHILD LOCK, MANUAL
4K3 T CZ WITH REMOTE CONTROL, INTERNAL ELEM. CONTROL, SAFETY
4L6 F INTERIOR REAR VIEW MIRROR WITH AUTOMATIC. DIMMING 90 150 4LC V CONTROL ELEMENT FOR MAGNETS AND BODIES.
4M0 T WITHOUT COOL ROOM (REAR SEAT BACK)
4N8 T FRONT PANEL, LEATHER
4QF T 3-POINTMACHINE. PER. REM. SECURITY., EL. REGULATION ON HIGH, MEM.
4UE T SAFETY CUSHION DRIVER / FRONT PASSENGER (DEACTIVATED)
4W0 T WITHOUT POCKET FOR CASE WITH CD-DISC / CASSETTE
4Z1 T STANDARD GLOVE BOX
5D1 C CARRYING FREQUENCY 433.92 MHZ
5K0 T BRUSHES GLASS CLEANER.
5RQ C OUTSIDE MIRROR, RIGHT, MOLDED
5SL T OUTSIDE MIRROR, LEFT, ASPHERIC
5TF F DECORATIVE INSERTS, LIGHT DER.
5W2 T DIRECTION SILVER. (PREPARED.DTS)
5XH T SUN VISORS, ILLUMINATED MIRRORS, DUAL
6A0 T WITHOUT FIRE EXTINGUISHER
6E6 T CENTER FRONT ARMREST, LEATHER (SMOOTH)
6EQ T AUX. STONE IMPACT BODY COVER II 90 150 6FA T WITHOUT CONTRAST 90 150 6GJ F SET EXPANDED WHEELS AROK., BODY COLORED (OTHER COUNTRIES
6KC T VENTILATION GRILLE, BLACK, LACQUERED
6N0 T WITHOUT MUDGUARD
6NN V CEILING LINING FROM ALCANTARA (OTHER COUNTRIES)
KRONNOE 6F1S LUGGAGE FLOOR COVERING.COMPARTMENT
6W1 C FRONT NUMBER PLATE BRACKET (LARGE) EC
6XT F OUTDOOR MIRROR, MEMORY, DARKER, SURFACE, FULL LEATHER 90 150 7AL C ALARM SIGNALING 12B3 T1 SECURITY SIGNALING SIGNALING T1 4 PCS), OTHER COUNTRIES 90 150 7E0 T WITHOUT BATTERY 90 150 7F7 F SELECT LEVER, WOOD, LIGHT, POLISH 90 150 7G5 C PR. EQUIPMENT FVS (VTS), DRIVER CARD, RETURN LOCK, SIGNAL
7K0 T WITHOUT TIRE PRESSURE MONITORING SYSTEM (CYE)
7M1 TSTEELS
7RV V ON NAVIGATION SYSTEM FOR RUSSIA
7T1 V PCM 3 – OFF-ROAD MODULE
7Y0 T WITHOUT LANE CHANGE ASSISTANT
8BC V XENON. HEADLIGHTS EEC, PRAVOSTOR. MOTION. 90 150 8DV V PCM 3 – BASE MODULE, REST OF COUNTRIES (WITH MAGNET)
8F2 T SIDE ROTARY INDICATORS
8FA T WITHOUT SECOND BATTERY
8GH T THREE-PHASE ALTERNATOR 190 A
8K8 F DAYLIGHTS, CONTROL SYSTEM. CLOSE. LIGHT. OTHER COUNTRIES 90 150 8L6 V SPACED. – ANTENA.
8N3 T INTERV. GLASS CLEANER., RAIN SENSOR
8Q3 T HEADLAMP CORRECTOR, AUTOMATIC, DYNAM.
8SA T REAR COMBINED LIGHTS, STANDARD VERSION
8T1 T CRUISE CONTROL
8TF T 2 REAR FOG LAMPS (LH + RH)
8WB T FOG LAMPS HEADLAMPS, NO ROOF HEADLIGHTS
8X1 T HEADLIGHT CLEANER
8Y1 T DOUBLE SOUNDS. SIGNAL 90 150 9AD T CLIMATRONIC, NOT USED FHUV
9JB T EXECUT. FOR SMOKERS, ASHTRAY + SOCKET SUPPLEMENT
9M0 T WITHOUT ADDITIONAL / AUTONOMOUS HEATER
9MB F INTERIOR LIGHTING COMFORT (WITH REG.BRIGHTNESS)
9NX T WITHOUT ELECTRONIC ON-BOARD MAGAZINE
9P1 T SEAT BELT MONITOR (DRIVER)
9Q1 T MULTI-FUNCTION DISPLAY / ON-BOARD COMPUTER
9T1 T WASHER NOZZLES, FR.
9TF T DOOR OPENING LIGHT COMFORT 90 150 9VL V RADIO 2 / RADIO HIGH-END 90 150 9WC T WITHOUT MULTIMEDIA IN REAR SECTION 90 150 9Z0 T OPERATING VOLTAGE A850 DISCHARGE TUBE BOTTOM SUSPENSION TOWELS A8 12 V
EXHAUST FOR DEFINIT. COUNTRIES MONT.
B37 C TYPE VERIFICATION COUNTRY LPG
C00 C OPERATING APPROVAL, FIRST RECORDING 90 150 D5Z T 8-CYL. BITURBO 4.8 / 368 KW (FL) 90 150 E0A T NO PERFORMANCE PROMOTION 90 150 F0A T NOT SPECIAL CAR STANDARD EXECUTED
FC0 T WITHOUT INDIVIDUAL MOUNTING
FE0 T WITHOUT COUNTRY CODE
FZ0 T SEAT BELTS, BLACK
G0R T 6-STAGE AUTOMATIC TRANSMISSION FOR FULL ACTUATORS
GP1 T AUTOMOTIVE. WITH ELEMENT. MODERN. PRODUCT
GY1 T REAR COVER CLOSER
HA8 F TIRES 295/35 R21 107 Y 90 150 J0Z T battery 520 A (110 Ah) 90 150 K4H T CLOSED VERSION 90 150 L0L C WITH LEFT STEERING WHEEL
N2S F.PARTIAL ALCANTAR LEATHER (SMOOTH)
NG0 T WITHOUT BASIC BRACKET
NY0 T STANDARD BATTERY / GENERATOR
Q1J F SPORT FRONT SEATS “GTS”
QA0 T WITHOUT CHILD SEAT (INTEGR.