An epidural corticosteroid injection (steroid injection) is, in the simplest terms, a method to quickly inject pain medication into the body using a syringe. The medication is administered to the epidural region. The epidural area is a fat-filled region that surrounds the spinal cord and protects it from injury. Sometimes, pain relief is temporary. Sometimes, the benefits last for a long time.
Around 2% of adults experience back pain from herniated discs at one time. A herniated disc, also known as a slipped disc or ruptured disc occurs when a disc fragment is pushed into a spinal canal, adding pressure on the nerves. This can cause severe pain, sometimes even debilitating, and lasts for different lengths of time. Epidural steroids may be the right treatment for you if your herniated disc pain is not subsiding.
What is a lumbar epidural steroids injection?
Lumbar epidural steroids injections (lumbar ESIS) are injections of anti-inflammatory medicine, such as steroid or corticosteroid, into the epidural space surrounding the spinal nerves in the low back. Lumbar epidural steroids are used to treat chronic pain due to irritation or inflammation of the spine roots (the lumbar area of your spine). Lumbar radiculopathy (radicular) is a form of chronic pain that can radiate from your low back down to your hips and legs.
What are the reasons I might need an epidural injection of steroids?
An epidural steroid injection may be a quick solution to your severe, difficult-to-treat pains in your arms or legs due to inflamed spinal neuros. This is often caused by narrowed nerve passages that run from your spine to your arms and legs. Inflammation of spinal nerves can result from this narrowing.
This narrowing may be caused by a variety of factors, including:
- Herniated disks
- “Slipped” vertebrae
- Joint cysts
- Bone spurs
- Spinal arthritis can cause weakening of the ligaments.
Injected steroids reduce inflammation, opening these passages for pain relief.
How does a lumbar epidural steroid injection work?
For chronic pain management, healthcare providers might recommend lumbar epidural steroids injections. Your provider may inject a corticosteroid or steroid medication into your epidural space near your spine cord. Lumbar spine refers to the lower back area of your spine. The lumbar spine is composed of five vertebrae. These vertebrae are the largest among all the vertebrae in the spine. They run from your lower thoracic (chest) to the bottom of your spine, at your sacrum.
Your spinal column is made up of 33 interconnected bones called vertebrae. These are located at the base and tailbones of your brain. These bones protect your spinal cord and allow you to turn. The disks between the vertebral bones provide flexibility and cushioning for your vertebrae.
From top to bottom, the five vertebrae of your lumbar spine can be referred to as lumbar 1 (L1) and lumbar 5(L5). The lumbar vertebrae play several important roles.
- Stabilizing and supporting your upper body.
- Allowing for twisting and bending.
- Protecting your spinal cord and cauda Equina (the nerves which descend from the bottom your spinal cord)
- Your spinal cord runs from your brain to the bottom of your spine. Your spinal cord functions as a highway connecting the nerves all around your body to your brain, so your brain can communicate with other parts of your body.
Sometimes nerve roots attached to your spinal cord’s lumbar region (lower back) can become inflamed or pinched. For example, this can happen if your disk is herniated. Inflamed nerves can lead to pain radiating down your legs.
Your provider will inject a steroid in the epidural space surrounding your spinal cord during a lumbar epidural steroids injection procedure. Your epidural space is shaped like a sleeve that surrounds your spinal cord. It contains fat, spinal nerves and blood vessels, as well as connective tissue. The steroid works by reducing pressure and swelling on the nerves and irritating the nerve(s).
Most people experience temporary pain relief with lumbar epidural steroids injections. However, some people may feel less or no pain relief.
What is the purpose of lumbar epidural steroids injections?
Lumbar epidural steroids are used by healthcare providers to treat lumbar radicular, a chronic type of pain that is caused by low back irritation and spinal nerve root inflammation. Sciatica is also known as lumbar radicular. Lumbar radicular symptoms can manifest as the following:
- Pain.
- Numbness.
- Muscle weakness
- Tingling.
There are many conditions that can cause low-back pain and lumbar radiculopathy (sciatica).
- Lumbar herniated disc: Also known as a slipped or ruptured disk, this condition can also be called a bulging, slipped or bulging disk. The disks are soft and have a gel-like center with a thicker outer layer. The outer layer can crack or become weaker over time, especially if there is an injury. Lumbar herniated disc is when the inner substance pushes through the crack between the two vertebrae of your low back. The leaked material could press on nearby spinal nerves, irritate or pinch them.
- Lumbar degenerative disc disease: This is when the cushioning between your vertebrae begins to wear away. Local inflammation could result from a degenerated disk.
- Lumbar spinal narrowing: This is a condition that causes a narrowing of one or several spaces in your lumbar spine. Your spinal nerve roots have less space if there is less space in your spine. If the space is too tight, it can cause nerve irritation or pinching, which can result in low back pain, particularly when you walk a lot.
- Lumbar osteoarthritis, also known as lumbar spondylosis, is a condition that causes changes in the bones and disks of your low back. This condition is caused by normal wear and tear from aging. Lumbar osteoarthritis may cause a narrowing of the spine in your low back, or the openings from which spinal nerves exit. This can cause irritation and inflammation to the nerves.
You may also be able to treat other conditions with lumbar ESISs:
- Axial low-back pain (localized): This can be caused by many things. This can cause dull or sharp pain, which can occur infrequently or continuously. It can also be severe.
- Neurogenic claudication is caused by compression of your spinal nerves in the lumbar spine. This condition can lead to tingling or pain in the low back, one or both legs, hips, and buttocks. These symptoms can be especially severe if you are standing straight up or walking.
What are the most common lumbar epidural steroids for pain management?
The most commonly used treatment for managing radicular discomfort is epidural steroid injections. Back pain is the fifth most frequent reason Americans seek medical attention. Approximately 9% to 25% of Americans report having low back pain and leg pain below the knee (radicular discomfort) each year.
Who can perform a lumbar epidural steroids injection?
Lumbar epidural steroids injections require precision. Healthcare providers who perform the injection must have extensive specialized training. The following healthcare providers may be able to perform lumbar epidural steroid injections:
- Physiatrists are providers of physical medicine and rehabilitation.
- Radiologists.
- Anesthesiologists.
- Neurologists.
- Surgeons.
How can I prepare for a lumbar epidural steroids injection?
It is important to inform your healthcare provider before your lumbar ESI. Your provider should also know what medications you are taking, including supplements and non-prescription drugs.
Your healthcare provider will provide you with specific instructions on how to prepare for your ESI injection. Follow their instructions. Your provider might:
- Before your lumbar ESIS, limit your eating and drinking.
- You may need to adjust certain medications, particularly blood thinners.
- To determine the precise area to be treated, you can request a CT or MRI scan of your back.
- If you are going to use a sedative to treat your lumbar ESI, make sure someone is there to drive you home.
Before you receive a lumbar epidural, steroid injection, there are some questions that may be useful to ask your healthcare provider:
- How often do you do lumbar ESIs (electro-lumbar)?
- What should I do in preparation for my lumbar ESI procedure?
- What are the potential risks associated with a lumbar ESIS?
- How will my lumbar ESI experience be?
- How long can my lumbar ESI be effective?
- What other options are there if a lumbar ESI is not effective in relieving my pain?
- What happens during a lumbar epidural injection of steroids?
Your lumbar epidural steroids injection will be done in an outpatient clinic or hospital. A lumbar ESI usually takes between 15 and 30 minutes. During this procedure, it is important to remain still.
Your healthcare provider may access your epidural space in your low back in a variety of ways.
- Interlaminar ESI: This method places the needle in the space between the two laminae of your spine. The flat plate of bone that is part of every vertebra in your spine is called a lamina. Your spinal cord is protected by the laminae, which are the outer walls of your spinal canal. Interlaminar Lumbar ESIs are used by providers to temporarily relieve pain from disc herniation, spinalstenosis, and low-back pain.
- Transforaminal ESI(TFESI): This method allows the needle to pass through the foramina. These are the openings through your spine through which nerve roots exit. Transforaminal lumbar ESISs are commonly used by providers to temporarily relieve radicular pain due to disk herniation, or an injury to a particular nerve root.
- Caudal ESIS: This method uses the sacral hiatus to guide the needle through your sacrum, just below your tailbone. It reaches the lowest spinal nerves. The sacrum, which is the triangular bone at your lower back and between your hip bones, is your caudal lumbar ESI. To temporarily relieve “failed back”, providers may recommend a caudal-lumbar ESI. Generally, ESIs that are caudal have fewer risks as interlaminar or transforaminal ESIs.
These are the steps for a lumbar epidural steroids injection procedure.
- Then, you will be changed into a medical gown. You will lie down on your stomach on a table with a pillow underneath. You may be given medication to help you relax, such a sedative.
- To minimize infection, your provider will clean and disinfect the area around the epidural site.
- Fluoroscopy, also known as radiology imaging or X-ray imaging, is a method of imaging guidance that helps guide the epidural needle into the correct position.
- The provider may inject local anesthesia using a small needle in the area where they will insert the epidural. The epidural needle is smaller than standard and will not cause as much pain.
- Your provider will inject contrast material once the epidural needle has been placed in the epidural space surrounding your spinal cord. Contrast material is used to ensure that the needle tip remains in the epidural space, and not within any blood vessels or tissue. This ensures that medication reaches the affected nerves.
- The provider will then slowly inject medication. This is often an anti-inflammatory medication such as a corticosteroid or steroid. Some providers may mix a corticosteroid with normal saline or a local anesthetic.
- After the provider has completed the injection, they will apply pressure to the area to stop bleeding, clean it again, and then apply a dressing. For a few minutes or an hour, you will be able to relax in a chair or a bed. This is to ensure your provider checks that you aren’t experiencing any adverse reactions before you leave for home.
How painful is a lumbar epidural injection of steroids?
Your provider will likely cause a slight pinch to the area just before you receive your lumbar epidural steroids injection.
It is possible to feel nothing during your lumbar ESIS, but you might feel the following:
- Pressure.
- Tingling.
- It is a burning sensation.
- Temporary pain
It is common to feel some discomfort after the injection. Usually, the pain will go away once it is completed. Tell your provider immediately if you feel severe, sharp pain after or during your lumbar ESI.
What side effects can lumbar epidural steroids injections have?
Side effects of lumbar ESISs include:
- Before the steroid medication begins to work, you may feel some temporary pain.
- There may be tenderness or bruising around the injection site.
- Fluoroscopy is used to guide imaging. Low-level radiation exposure will not be an issue. Fluoroscopy Xrays can be harmful to unborn babies. Before you have the procedure, tell your doctor if you are pregnant.
- An epidural steroid injection can cause hyperglycemia (high blood sugar) if you have diabetes. This can last hours, or even days.
- An ESI can temporarily raise your blood pressure and eye pressure if you have glaucoma.
How long does it take for a lumbar epidural injection to start?
After your lumbar ESIS, your pain might get worse for two to three days before it starts to improve. The pain relief may last for several days or even months.
RISKS/BENEFITS
What are the benefits of lumbar epidural steroids injections? There are many benefits to lumbar epidural steroids injections:
- Temporary pain relief may be possible.
- Rehabilitation exercises may be able to provide enough pain relief for you to take part in the treatment of low back pain.
- Pain relief may lead to a higher quality of life and a greater ability to perform daily activities.
- Lumbar epidural steroids injections could reduce the need to have more invasive procedures such as surgery for pain management.
What are the possible risks and complications of lumbar epidural steroids injections?
Although epidural steroid injections to the lumbar spine are generally safe, there are some side effects and complications. Even though complications and risks are rare, lumbar ESI injections can cause:
- Low blood pressure can cause lightheadedness.
- Spinal fluid leakage can cause severe headaches.
- Infections resulting from epidural procedures, such as discitis or osteomyelitis, meningitis, epidural abscess and discitis.
- A negative reaction to medications such as hot flashes, rash or itchy skin.
- Bleeding can occur if the blood vessel is damaged accidentally during an injection. This could lead to a hematoma, or a bloodclot.
- Nerve damage at the injection site
- Temporarily losing control over your bladder or bowels. To help you pee, you might need a catheter (a small tube in your bladder).
- Too many ESI injections or higher doses may cause bone loss in your spine and muscles nearby. Most healthcare providers limit the number of ESIs that a patient can receive per year to between two and three.
Are there long-term side effects from lumbar epidural steroids?
Although it is rare, lumbar epidural steroids injections can cause long-term complications.
- Permanent neurologic deficit caused by spinal cord injury or nerve root damage following epidural injection.
- Chronic pain caused by nerve root or spinal cord damage after epidural injection.
- Permanent paralysis is caused by a hematoma, which is a buildup in blood between your spinal cord and the dura mater.
What are the prospects for lumbar epidural steroids injection therapy?
Some people feel temporary pain relief after lumbar epidural steroids injections. Others experience long-term relief that lasts up to 12 months. Some people don’t experience pain relief with ESIs. Lumbar epidural steroids injections are intended to provide short-term pain relief. This allows you to continue or start physical therapy, or to avoid more intense pain relief. By strengthening your spine muscles, physical therapy can help to provide long-term pain relief. Your healthcare provider might recommend another injection if the lumbar ESI is successful and provides pain relief. Most providers restrict people to one to three ESIs each year.
What happens following an epidural corticosteroid injection?
After the procedure is completed, you are allowed to return home. You can usually return to your normal activities the next day. The steroids typically work within one to three days. Sometimes, it may take up to seven days to see the effects. The injections can provide a long-lasting improvement in pain and function for many people. The injection can be repeated if it is successful. You should contact your healthcare provider if you experience side effects. Talk to your healthcare provider if you aren’t experiencing pain relief. This could be an indication that your pain is not coming from the spinal nerves.
When do I need to see my healthcare provider
After you return from your lumbar ESI, if you have any of these symptoms, contact your healthcare provider immediately.
- If you feel severe headaches while standing or sitting, it could be a sign that your body is not used to the position. This could indicate a dural puncture.
- A fever could indicate an infection.
- A reduced or complete loss in bladder control or bowel control.
- Nerve injury can cause weakness and numbness in the legs.
Next steps
Before you consent to the test or procedure, make sure you understand:
- The procedure or test name
- Why are you having the procedure or test?
- What to expect from the results and what they mean
- The benefits and risks of the procedure or test
- What are the possible side effects and complications
- What time and where are you going to have the procedure or test?
- What are the qualifications of the person who will perform the test/procedure?
- What would you do if the procedure or test was not available?
- Are there any other tests or procedures you might be interested in?
- How and when will you achieve the results?
- If you have any questions, or need assistance after the procedure or test, who do you call?
- What amount will you need to pay for the procedure or test?
