What is a Lumbar Epidural Steroid Injection?

Lumbar epidural steroid injections explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Back PainA lumbar epidural steroid injection is a non-surgical treatment method for the management of lower back and radicular pain. The technique was initially utilized in the 1950s as an alternate approach for sciatica and lumbar pain.

The purpose of this procedure is to inject a steroid medication into affected nerves as a means of reducing inflammation. If the injection is successful, pain relief may be experienced in the lower back and additional symptoms such as pain in the legs, numbness, and tingling may also decrease.

Lumbar steroid injections actually have two primary functions. These include pain management and the ability to be used as a diagnostic tool. In particular, if medication is injected into a specific region (e.g. lumbar region) and the pain stops, then the cause of the pain can be accurately identified. This also indicates that the pain was the result of inflamed nerves. Based on the therapeutic results, a physician will then decide whether to recommend additional injections, physical therapy, or refer the patient to a surgeon for a more thorough evaluation if the injection did not produce positive outcomes.

How is a Lumbar Epidural Steroid Injection Performed?

Preparation For ProcedureBefore the injection is performed, the patient is positioned on the stomach and a disinfectant is used on the skin to prevent the development of an infection. If a patient needs to be sedated, than an IV that contains an analgesic will be used and the patient’s vital signs will be monitored. An anesthetic is also generally applied to the skin prior to the injection. A physician will use an imaging technique such as fluoroscopy while inserting the needle to make sure it is properly positioned.

Once the targeted region is confirmed with the use of a contrast dye, the steroid medication as well as an anesthetic are injected into the affected area. The injection process usually takes about 15 minutes. Patients have reported experiencing the benefits of this pain treatment a few days after receiving the injection.

One of three forms of lumbar steroid injections are typically administered to patients. The most commonly administered form is the interlaminar injection that involves inserting the needle between the vertebrae and the lamina that are located in the middle region of the back. The medication is then injected into the spine on both sides.

Epidural InjectionA second approach is known as the transforaminal injection, in which the needle is inserted through the side of a vertebra into the neural foramen and the medication is only delivered to one side of the spine. This approach is often performed to prevent the development of scar tissue and to avoid affecting bone grafts in patients who previously had back surgery.

The third approach is called a caudal injection. This procedure entails inserting the needle into the tailbone region in the large sacral canal. The advantage of utilizing this method is that large amounts of steroids can be administered to the epidural space.

Clinical research has repeatedly demonstrated the effectiveness of lumbar epidural steroid injections for lower back pain. Some of the studies have even emphasized that utilizing lumbar epidural steroid injections early on may prevent a patient from having to undergo back surgery. One particular study that was published in the journal of Current Sports Medicine Reports explained that transforaminal steroid injections have the ability to significantly reduce the rate of surgical procedures.

An additional clinical trial that was recently published involved a comparison of patients who received lumbar epidural steroid injections for herniated discs to patients who did not receive injections. The results showed that more than 50% of the patients who received the injections did not need any form of surgical intervention in comparison to approximately 19% of the patients who were not treated with the injections.

This procedure is considered to be minimally invasive, but there are certain risks associated with steroid injections such as insomnia, hot flashes, bleeding, infection, and elevated blood sugar.

Conditions Related To Epidural Lumbar Steroid Injections

Ruptured DiscThe following conditions have been effectively treated with lumbar epidural steroid injections:

  • Spondylolysis, which is the degeneration of the spine
  • Spinal stenosis, which is the narrowing of the spinal canal
  • Herniated discs, which occurs due a bulging or ruptured disc
  • Lumbar radiculopathy, which is pain that radiates through the legs due to spinal nerve compression
  • Degenerative disc disease, which occurs due to the gradual wear and tear of intervertebral discs

Conclusion

Lumbar epidural steroid injections are a widely utilized method for pain management, especially for the lower back. Patients who receive this type of injection experience rapid pain relief, improved mobility, and a better quality of life without having to undergo an invasive surgical procedure.

At Pain Doctor our goal is to relieve your pain and improve function to increase your quality of life.
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References

  1. Coliman F, Villalobos F. Epidural steroid injections: Evidence and technical aspects. Techniques in Regional Anesthesia and Pain Management. 2010;14;113-119.
  2. Collighan N, Gupta E. Epidural steroids. Brit J Anaesth. 2010;109(1):1-5.
  3. Friedrich J, harrast M. Lumbar epidural steroid injections: indications, contraindications, risks, and benefits. Current Sports Medicine Reports. 2010;9(1):43-49.
  4. Ghai B, Vadajae KS, Wig J, Dhillon MS. Lateral parasagittal veres midline interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain: A double-blind randomized study. Anesth Analg. 2013;117(10):219-227.
  5. Manchikanti L, Cash K, McManus C, Damron K, Pampati V, falco F. Lumbar interlaminar epidural injections in central spinal stenosis: Preliminary results of a randomized, double-blind active control trial. Pain Physician. 2012;15:51-63.
  6. Sukdeb D, Ramsin M, Laxmaiah M. Evidence-based practice of lumbar epidural injections. Techniques in Regional Anesthesia and Pain Management. 2009;13:281-287.