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Lumbar Epidural Steroid Injection

A lumbar epidural steroid injection is a conservative treatment used to relieve back pain and sciatica, which is a combination of low back pain and leg pain. These types of pain may be caused by a number of conditions, including lumbar radiculopathy, lumbar spinal stenosis, lumbar disc herniation and failed back surgery.

What Is a Lumbar Epidural Steroid Injection?
A lumbar ESI is an outpatient treatment that consists of long-acting corticosteroids and local anesthetic injected into the epidural space of the spine. The dura is a protective coating that surrounds the spinal cord, and the epidural space is a small area between the dura and the bones of the spine. The epidural space is rich in blood vessels, and the injection of steroids into it may reduce the low back pain, leg pain and sciatica caused by several medical conditions.

Indications for Lumbar Epidural Steroid Injections
The inflammation and pain associated with the following conditions are some of the indications for treatment through a lumbar ESI:

• Lumbar disc herniation or disc protrusion
• Lumbar radiculopathy or lumbar radicular pain
• Lumbar spinal stenosis
• Failed back surgery

About the Procedure
Before a lumbar ESI can be performed, we will perform a comprehensive history and physical examination as well as review of pertinent imaging. We will attempt to inject the steroids as close to the painful area as possible. In order to position the needle properly, we use a portable x-ray device, also called a fluoroscope, for precise needle localization. Contrast dye is injected to ensure proper needle placement within the epidural space.

Lumbar Epidural Steroid Injection

After the Procedure
Most patients can walk away from this conservative treatment under their own power, but they may feel weak, dizzy or tired. Because of this, it is recommended that patients do not drive themselves home afterward, but most are able to resume their usual activities the following day.

Risks
Lumbar ESI is considered a low-risk procedure but some possible risks include:
• Infection
• Allergic reaction
• Bleeding
• Nerve damage

Sources
“Epidural Steroid Injection (ESI).” Mayfield Clinic & Spine Institute. http://www.mayfieldclinic.com/PE-ESI.htm.

“Epidural Steroid Injections.” Medscape Reference. http://emedicine.medscape.com/article/325733-overview.

“Lumber Radiculopathy.” American Association of Neuromuscular & Electrodiagnostic Medicine. http://www.aanem.org/Education/Patient-Resources/Disorders/Lumbar-Radiculopathy.aspx.

“Lumbar Transforaminal Epidural Steroid Injections.” North American Spine Society. http://www.spine.org/Documents/LTFESI_ReviewRec_Statement.pdf.