Epidural steroid injections (ESIs) have been commonly used in the treatment of low back and leg pain since 1952 and still make up an essential part of non-surgical pain management of sciatica and other low back pain problems. A lumbar epidural steroid injection (LESI) delivers a steroid medication directly to the spinal nerve roots that reside in the lumbar (lower back) region, in order to provide relief from painful symptoms.
Potential causes of lumbar or low back pain can include:
- Herniated or bulging disc
- Osteoarthritic bone spurs
- Lumbar spinal stenosis
- Degenerative disc disease
- Synovial cyst in the lumbar spine
- Annular Disc Tear
Essentially, any condition or injury that causes nerve root irritation and inflammation can lead to lower back pain and referred pain from lumbar nerve roots. A common example of referred pain from general compression or irritation of the lumbar nerve roots is a condition known as sciatica.
The sciatic nerve is the longest and largest spinal nerve in the human body. This nerve originates from the lower spine, extending all the way down the back of the leg to the toes, delivering nerve signals to the muscles and skin along the way. Therefore, if this nerve becomes injured or irritated in the lower spine, pain symptoms can travel from the lower back, through the pelvis, and down each leg. The pain felt in the leg from sciatica is often much worse than pain felt in the back.
Managing Lumbar Spinal Pain with Epidural Steroid Injections
Pain that emanates from compressed or irritated nerves of the lower back can be managed with lumbar epidural steroid injections. This type of injection delivers a steroid medication (‘cortisone’) mixed with a local anesthetic into the epidural space. The epidural space is the fat filled ‘sleeve’ that surrounds and provides cushioning for the spinal cord and nerve roots.
As opposed to oral steroids and painkillers, steroid injections can deliver very potent anti-inflammatory medication directly to the source of pain. This method provides a more targeted and powerful impact on symptoms with less overall side effects. Additionally, an ESI can help with “flushing out” inflammatory proteins and chemicals from the area that may be contributing to or exacerbating pain.
Although lumbar epidural steroid injections do not eliminate the underlying condition, they do provide enough pain relief to allow the patient to move forward with their rehabilitation program. Breaking the cycle of inflammation and pain allows the body to compensate and improve function. For this reason, the benefits of the injection often outlast the effects of the steroid medication itself.
Methods for Delivering Steroid into the Epidural Space
There are multiple approaches to reach the lumbar epidural space. The three most commonly used methods for the application of edpidural steroids include:
The interlaminar approach is currently the most common method used for epidural injections. All three approaches involve the placement of a thin needle utilizing x-ray guidance (flouroscopy). Prior to the steroid injection, a contrast dye is used to confirm that the medication will flow into the desired region.
An interlaminar ESI, which is often simply referred to as an ‘epidural injection’, places the needle into the back of the epidural space, delivering the steroid medication over a wider area. Similarly, the caudal approach uses a small boney opening just above the tailbone, known as the sacral hiatus. This method allows for needle placement at the very bottom of the epidural space. A transforaminal ESI, which is often referred to as a ‘nerve block’, places the needle alongside the nerve as it exits the spine, administering medication into the ‘nerve sleeve’. The medicine then travels up the sleeve and into the epidural space from the side. This approach allows for a more concentrated delivery of the steroid into one affected area (e.g. one segment or one side). This type of injection can be modified for more specified coverage of a single nerve, providing enhanced diagnostic benefit, along with improved function and pain relief.
Learn More About LESIs or Schedule an Appointment
If you would like to learn more about lumbar epidural steroid injections or would like to schedule an appointment with Dr. Robert S. Marks, Dr. Sauman A. Rafii, or Dr. Ivan N. Chew, please contact the Diagnostic Pain Center today at (512) 981-7246.