Lumbar Epidural Steroid Injection

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

The lumbar area of the spine has five vertebrae (bones). Soft discs sit between these vertebrae to cushion them, hold them together, and help control motions.

If one of these disc tears, the fluids inside may leak out, inflaming the nerve roots or the dura and causing pain. A large disc tear may cause a disc to bulge, which leads to the same results. Bone spurs called osteophytes can also press against nerve roots and cause pain.

If you have pain in your lower back when you bend it, you may have lumbar disc or dural inflammation. If the pain travels down to your leg when you move your back, you may have nerve root inflammation.

MRIs may show disc bulges and nerve root compression, but may not show a torn or leaking disc. A lumbar epidural injection may provide relief if disc problems or dural, or nerve root inflammation are causing your pain.

In a lumbar epidural injection, a corticosteroid is injected into the epidural space to reduce inflammation. A local anesthetic may also be injected to numb your pain. The simplest and most efficient way to perform this procedure is from the back of the spine. This is called an interlaminar injection because it is administered between two laminae, or layers, of the vertebrae. 

First, a local anesthetic will be used to numb your skin. Once you are effectively numbed, your doctor will insert a small needle directly into the epidural space. A type of x-ray called fluoroscopy will be used to ensure the safe and proper positioning of the needle. A dye will also be injected, which your doctor will use to guide the needle to the right spot. Once your doctor is sure of the needle placement, the medications will be injected.

After your injection is complete, you'll be monitored for up to 30 minutes. When it's time to leave, the staff will give you discharge instructions and a pain diary. Filling out the pain diary helps your doctor know how the injection is working.

It will also help to move your back in ways that hurt before the injection to see if the pain is still there. But be careful not to overdo it, take it easy for at least the rest of the day.

You may feel immediate pain relief and numbness in your back and leg for a while after the injection, which usually indicates that the medication has reached the right spot.

Your pain may return after or may even be worse for a day or two. This is common and is caused by needle irritation or the corticosteroid. Corticosteroids usually take two or three days to start working but can also take up to a week. If you plan to return to work the day after your injection, you will likely be able to do so, but you should check with your doctor first.

The extent and duration of pain relief may depend on the amount of disc, dural or nerve root inflammation you're experiencing, along with other individual factors. If we find that coexisting factors are responsible for your pain, we will evaluate them to determine the best course of action moving forward. 

For some patients, an injection brings several weeks or months of pain relief before further treatment is needed. For other patients, a single injection brings long-term pain relief. If your pain is caused by injuries to more than one area, only some of your symptoms may be helped by a single injection. Keeping a detailed pain diary will help us evaluate your symptoms, treatment areas, and necessary steps.