Lower Back & Leg Pain
A lumbar epidural steroid injection is a procedure to help relieve low back and leg pain. It works by reducing inflammation of irritated nerves within the spinal canal. These nerves can be irritated as a result of a herniated lumbar disc or because of degeneration of the spine. The discs are "cushions" between the vertebrae that can degenerate as a result of injury or advanced age. When a disc loses its integrity, it can spill irritating chemicals onto spinal nerves and it can also cause direct pressure effects. Arthritis causes nerve irritation because this degenerating process narrows the canals where the nerves lie.
An epidural steroid injection is very safe with potential benefits of decreased pain, decreased numbness/tingling, and increased mobility. As with any procedure, there are risks involved including infection, bleeding, nerve injury, and worsened pain. There are also possible side effects relating to the steroid itself including: increases in blood sugar, weight gain, water retention, and suppression of the body's own production of cortisone.
The procedure itself is performed at an outpatient surgery center. Usually, an IV (intravenous) line is started preoperatively in order to give the patient mild sedation.
- The patient is then brought to the procedure suite and placed in the prone (face down) or seated position.
- The skin is cleansed with an antiseptic solution and drapes are placed to keep a sterile field.
- To be as precise as possible, the physician uses an x-ray machine to visualize the spinal anatomy.
- Next, the skin and subcutaneous tissues are anesthetized with a local anesthetic (lidocaine).
- An epidural needle is then inserted and advanced to the area surrounding the spinal cord and the nerves coming out of it, which is called the epidural space.
- Contrast "dye" may be used to assure proper needle position as it outlines the intended target.
- During the injection of steroid, the patient may feel slight discomfort from the pressure effects of the injected solution.
- This entire procedure may take 10-15 minutes.
- After the procedure is over, the patient is taken to the recovery area for approximately 30 minutes before being discharged.
After the Procedure
After the procedure, there may be some slight discomfort from the mechanical process of needle insertion or from pressure effects from the solution. Usually the procedure is very well tolerated and patients can resume their normal activities the next day. The steroid takes approximately 24-48 hours to take effect, so patients should not expect any immediate benefit. It is not infrequent that it takes 2 to 3 epidural steroid injections to obtain the most benefit.