A Lumbar Epidural Steroid Injection (LESI) is a common medical procedure used to treat lower back pain, especially pain that radiates down the legs (sciatica). The procedure involves injecting a combination of a steroid medication and a local anesthetic into the epidural space in the lumbar (lower back) region of the spine. The goal is to reduce inflammation and relieve pain caused by conditions such as herniated discs, spinal stenosis, or nerve root irritation.
What is a Lumbar Epidural Steroid Injection?
The lumbar epidural space is located around the spinal cord and nerve roots in the lower back. In this procedure, a needle is inserted into the epidural space, and the medication is delivered near the irritated or inflamed nerve roots. The steroid medication helps to reduce inflammation and swelling, which can relieve pain and improve mobility.
Conditions Treated with Lumbar Epidural Steroid Injections
LESIs are typically used to treat pain related to:
- Herniated or bulging discs: When the soft inner part of a spinal disc protrudes and compresses nearby nerves.
- Spinal stenosis: Narrowing of the spinal canal, which can put pressure on nerve roots.
- Degenerative disc disease: When the intervertebral discs in the spine break down, leading to pain and nerve irritation.
- Sciatica: Pain that radiates from the lower back down one or both legs due to compression or irritation of the sciatic nerve.
- Nerve root irritation or inflammation: Caused by conditions such as arthritis, where the nerve roots become inflamed and painful.
How Does a Lumbar Epidural Steroid Injection Work?
The procedure involves the injection of a steroid and sometimes a local anesthetic into the epidural space of the lumbar spine. Here's a breakdown of the process:
- Preparation:
- You may be asked to lie on your stomach or side on the procedure table.
- The skin over the injection site is cleaned and sterilized, and a local anesthetic is applied to numb the area.
- Fluoroscopic Guidance:
- The doctor uses fluoroscopy (real-time X-ray) to guide the needle to the correct location in the lumbar spine. This ensures that the injection is accurately placed near the nerve root or affected area.
- Injection:
- Once the needle is in place, a combination of a steroid (such as methylprednisolone or dexamethasone) and a local anesthetic (such as lidocaine or bupivacaine) is injected into the epidural space. The steroid reduces inflammation and pain, while the anesthetic provides temporary relief by numbing the area.
- Post-Injection:
- After the injection, you'll be monitored for a short period to ensure you don't have any immediate adverse reactions.
- You may experience mild discomfort or soreness at the injection site, but this typically resolves within a few days.
Benefits of Lumbar Epidural Steroid Injections
- Pain Relief: The primary benefit of LESIs is relief from lower back pain, particularly when the pain is caused by nerve root irritation or inflammation. This can improve quality of life and mobility.
- Reduction in Inflammation: The steroid reduces inflammation in the epidural space, which can reduce swelling around the nerve roots and decrease pain.
- Improved Functionality: By reducing pain, LESIs can help patients regain mobility and return to normal activities, often in combination with physical therapy and other treatments.
- Non-Surgical Option: LESIs provide a non-invasive alternative to surgery, which is especially helpful for people with conditions like herniated discs or spinal stenosis who want to avoid surgery or are not candidates for it.
Risks and Side Effects
While the procedure is generally safe, there are potential risks and side effects to be aware of:
- Temporary Pain or Discomfort
- Headache: Some people experience a headache after the procedure, particularly if the needle inadvertently punctures the protective layer around the spinal cord (dural puncture). However, this is rare.
- Nerve Damage: Although rare, there is a small risk of nerve injury or damage to the spinal cord during the procedure.
- Steroid Side Effects: Prolonged use of steroids can have side effects such as weight gain, increased blood sugar, or weakened bones. However, the steroid injection is typically used in a controlled manner with minimal systemic effects.
Effectiveness of Lumbar Epidural Steroid Injections
- Short-Term Relief: Many patients experience significant pain relief within a few days to a week of receiving the injection. This relief can last for several weeks or even months, depending on the individual and the underlying condition being treated.
- Long-Term Relief: In some cases, a single injection may provide long-lasting relief, but others may require multiple injections over time. The effectiveness of the injection can vary based on the severity of the condition and individual factors.
- Temporary Solution: LESIs do not cure the underlying condition causing the pain. They are meant to manage symptoms and provide relief, often as part of a broader treatment plan that may include physical therapy, medications, and lifestyle changes.
How Many Injections Are Needed?
- Most doctors limit lumbar epidural steroid injections to a maximum of 3 to 4 injections per year. This is due to the potential side effects of long-term steroid use, such as weakening of bones or tissues.
- The exact number of injections needed will depend on the patient's condition and the response to the injection.
Who is a Candidate for a Lumbar Epidural Steroid Injection?
Candidates for LESIs include individuals who:
- Have been diagnosed with conditions like herniated discs, spinal stenosis, or degenerative disc disease.
- Experience persistent pain that radiates to the legs (sciatica), especially when conservative treatments such as physical therapy, medications, or rest have not provided adequate relief.
- Want to avoid surgery or are not candidates for surgery.
- Have an accurate diagnosis of the condition that is causing their pain.