Learning About Lumbar Epidural Steroid Injections

What is a lumbar epidural steroid injection?

A lumbar epidural steroid injection is an injection (shot) of medicine into the epidural space of your lower back. The epidural space sits between the bones in your spine (called vertebrae) and the spinal cord. This space contains nerve roots, tissue, and small blood vessels.

The injection will have a steroid to reduce pain and swelling. It may also have a local anesthetic (numbing medicine) to numb nerves and stop them from sending pain signals to your brain.

Why is it done?

It’s done to treat pain in your lower back (called the lumbar region). The pain may also travel down into your hips or legs.

Lower back pain often happens because of a slipped, ruptured, or bulging disc (called a herniated disc). The vertebrae in your spine are cushioned by soft discs. If a disc is injured, the soft, jelly-like filling can leak out and cause painful swelling. Pain may also be caused by bone spurs pressing against nerve roots or by other injuries to your spine.

How can you prepare?

Before the injection, your doctor may do an imaging test (like an MRI, CT scan, or X-ray) to show which area of your spine is causing pain. Make sure to:

• Tell your doctor about any medicines or supplements you take. This is especially important if you take blood thinners, since those medicines could cause problems during the procedure.
• Tell your doctor if you have diabetes. The medicine used in the injection can raise your blood sugar, so you may need to adjust how you manage your diabetes right before and after.
• Let your doctor know if you might be pregnant.
• Follow any directions your doctor may give you for not eating or drinking before getting the injection.

How is it done?

There are three main ways to do a lumbar epidural steroid injection: the interlaminar approach, the transforaminal approach, and the caudal approach. The difference between them is the way the needle is placed to give the medicine. You and your doctor will decide which one is best for you, based on your body and what’s causing your pain.

All three approaches start out the same. You might get a sedative through a vein in your arm. This is medicine to help you relax. Then you’ll lie on an exam table on your belly. Your doctor or nurse will clean your skin with an antiseptic and numb the area where you’ll get the injection.

To find the right spot for the injection, your doctor will use fluoroscopy (a type of X-ray) to help guide them. They may also use contrast material, or contrast dye, to make the area more visible on the X-ray.

• For an interlaminar epidural steroid injection,your doctor will insert the needle between two laminae in your spine and into the epidural space. Laminae are flat plates of bone that are part of the vertebrae in your spine.
• For a transforaminal epidural steroid injection,your doctor will insert the needle through the foramina into the epidural space. Foramina are openings between the vertebrae where nerve roots and blood vessels go from the spinal cord to the rest of your body.
• For a caudal epidural steroid injection, your doctor will insert the needle into an opening in your sacrum. The sacrum is the triangular bone at the bottom of your spine, just above your tailbone.

The procedure will take about 15 to 30 minutes. You may feel some pressure, stinging, or burning during the injection. Let your doctor know right away if you start feeling intense pain at any point.

What happens afterward?

If your injection had local anesthetic and a steroid, your legs may feel heavy or numb right after. You will probably be able to walk, but you may need to be extra careful. Take care not to lose your balance, and be sure to follow your doctor's instructions.

You’ll probably be able to go home about an hour after the procedure. But you’ll need someone to drive you home from the hospital.

If your injection had a local anesthetic, you may feel better right away. But this pain relief will last only a few hours. Your pain will probably return. This is because the steroids take about 1 to 5 days to start working. Before the steroids start to work, your lower back may be sore for a few days.

For some people, pain gets worse right after the injection before it starts to improve. If you start having severe pain, reach out to your doctor for help.

How long does pain relief last?

Relief from the injection may last for a few days, weeks, or even months. It all depends on what’s causing your pain. For some people, the pain will be gone for good after one injection. Others may need more treatment if the pain comes back.

There is a chance that the injection won’t work to relieve pain. If that happens, you’ll work with your doctor to try other things.

What are the side effects and risks?

The most common side effect is bruising or pain where you got the injection. You might also have side effects from the steroids, like a flushed or warm feeling on your face and chest or trouble sleeping. These usually go away within a few days.

Serious problems are rare, but they can happen. These include:

• Infection or bleeding.
• Nerve damage, including damage to the spinal cord.
• Temporary paralysis (inability to move).
• Allergic reaction to a medicine.

When should you contact your doctor?

Contact your doctor right away if you have:

• Symptoms of an infection, like fever, chills, or severe swelling and redness at the injection site.
• Severe pain.
• Headaches, especially when standing up or sitting upright.
• Numbness or weakness that’s getting worse.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and contact your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.