Patients who have cycled through epidural steroid injections without lasting relief frequently have an unrepaired annular tear that the injections cannot reach. The AAFP review found epidural steroid injections ‘not effective’ for chronic low back pain. The fibrin procedure delivers sealant directly into the tear, addressing the source rather than the surrounding inflammation.
Key Takeaways
- Epidural steroid injections target inflammation, not tears.
- AAFP found ESIs ‘not effective’ for chronic low back pain.
- Persistent pain after multiple ESIs suggests an unrepaired tear.
- The fibrin procedure addresses the tear directly.
- Mechanism is reparative, not anti-inflammatory.
What This Guide Covers
- What does an epidural steroid injection do?
- Why does ESI relief fade?
- How does the fibrin procedure differ?
- When should a patient shift from ESIs?
What does an epidural steroid injection do?
ESI delivers anti-inflammatory medication to the area around the nerve root. It calms inflammation and the pain that inflammation drives. Effects last weeks to months in patients who respond. The injection does not seal annular tears.
Why does ESI relief fade?
Relief fades because the underlying tear remains active. The tear keeps generating inflammatory chemistry. Each new round of inflammation drives the next round of pain. The cycle repeats until the lesion is addressed.
How does the fibrin procedure differ?
The fibrin procedure delivers an FDA-approved fibrin sealant into the tear under fluoroscopic guidance. The sealant scaffolds tissue healing. The mechanism is reparative — addressing the source — not anti-inflammatory.
When should a patient shift from ESIs?
When repeat ESIs fail to produce durable relief and imaging shows discrete annular tears, the candidacy conversation for the fibrin procedure becomes appropriate.
Clinical Note
Patients sometimes assume more ESIs will eventually produce different results. Our clinical staff treats that pattern as the cycle to break. ESIs are excellent at what they do — calm inflammation. They are not designed to seal tears. When the tear is the active driver, more inflammation control will not change the trajectory. The procedure addresses a different layer.
Frequently Asked Questions
Have I had too many injections to consider the procedure?
No. Prior injection history does not preclude the procedure.
Should I stop injections before the procedure?
Coordination with pain management is part of the intake.
How long after my last ESI can I have the procedure?
The clinical team confirms timing during evaluation.
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This content is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified physician. Treatment decisions depend on your individual medical history and clinical findings. Schedule a consultation to discuss whether the procedure is right for you.
