Lumbar Epidural Steroid Injection for Lower Back & Leg Pain

What is the Epidural Space?

The dura is a protective covering of the spinal cord and its nerves. The area surrounding the dura is the epidural space. In the lower back, the space is called the lumbar epidural space.

What Causes Pain in the Epidural Space?

The lumbar area of the spine has five bones, called vertebrae. Soft discs between the vertebrae act as cushions, offering support and controlling motion. If a disc tears, chemicals inside may leak out, causing inflammation of nerve roots or the dura, and pain.
A larger tear may cause a disc to bulge, resulting in inflammation and pain. Bone spurs, called osteophytes, can also press against nerve roots and cause pain.

How Do I Know if I Have Disc and Nerve Root Pain?

Your doctor can determine the cause of the pain. If you have pain in your lower back when you move, you may have disc or dural inflammation.If pain travels to your leg when you bend your back, you may have nerve root inflammation.

Common tests, such as MRIs, can show disc bulges and nerve root compression, but may not show a torn and leaking disc. A lumbar epidural injection can help determine if disc, dural, or nerve root inflammation is causing your pain.

What is a Lumbar Epidural Injection?

During this procedure, a corticosteroid (anti-inflammatory medicine) is injected into the epidural space to reduce inflammation and pain. Your physician may inject into the epidural space from behind. This is called interlaminar injection.

When your physician goes in from the side, it is called a transforaminal injection. If the needle is positioned next to an individual nerve root, it is called a selective nerve root block. When performed from below it is called a caudal injection.

What Happens During an Injection?

An IV may be inserted to administer intravenous medication(s) to help you relax. A local anesthetic will be used to numb your skin. Fluoroscopy, a type of x-ray, will be used to insure the safe and proper position of the needle. A dye will also be injected to make sure the needle is in the correct spot. Once your physician is sure the needle is correctly placed, the medicine will be injected.

What Happens After an Injection?

You will be monitored for up to 30 minutes after the injection. Before you leave, you will be given discharge instructions, as well as a pain diary. Keeping track of your pain will help the doctor know what the next step will be.Your pain may become a little worse for a day or two. This is normal. It may be caused by needle irritation or by the steroid itself. Steroids usually take two or three days to start working, but can take as long as a week.

You should be able to return to work the day after the injection, but always check with your doctor.

How Long Until Can I Expect Pain Relief?

The amount and duration of pain relief varies from person to person and is dependent on many factors including underlying pathology and activity level. Some can have relief that lasts years, while others have short- term relief.

Usually a series of injections, often three, each spaced a week or two apart, are given. It is important to discuss with your physician your response to the epidural steroids in order to plan future treatment options.