What is a lumbar epidural steroid injection?

A lumbar epidural steroid injection (LESI) is an injection of corticosteroids (similar to cortisone) into the space just outside the covering (the dura) of the spinal cord in your lower back. Because the injection is outside (epi) the dura, it is called an epidural injection.

What are the indications for a lumbar epidural steroid injection?

These injections are performed when it is thought that spinal nerve inflammation is part of the process that is causing the pain. Common indications for lumbar epidural steroid injection include herniated discs, degenerative disc disease, radiculopathy or radiculitis, and spinal stenosis.

How do epidural steroid injections help my pain?

The spinal cord travels from the brain to the waist in a tunnel in the back part of the spine. About every inch along the way, the spinal cord gives off branches (spinal nerves) to the right and left. These spinal nerves carry sensations and pain signals from the various parts of the body back to the brain.

Corticosteroids are very potent anti-inflammatory medications that work best when they are injected into the area where the inflammation is occurring. Because the spinal nerves pass directly through the epidural space, a lumbar epidural steroid injection allows the medication (steroid) to come into direct contact with the inflamed spinal nerves, reducing the pain associated with the inflammation.

How do I prepare for a lumbar epidural steroid injection?

A lumbar epidural steroid injection is a minor surgical procedure that is typically performed in the physician’s office or an ambulatory surgery center. You should not eat or drink anything for at least 2 hours before your procedure. You should take all of your medicines except blood thinners the day of your procedure.

What should I expect during the lumbar epidural steroid injection?

You will be lying face-down on an X-ray table during the lumbar epidural steroid injection. You may have pillows placed under your abdomen to help your surgeon with optimal positioning. Live X-rays (called fluoroscopy) will then be taken to ensure proper positioning.

Your back will then be cleaned with an antiseptic solution and a sterile drape will be placed over this area to keep it clean for the procedure. A local anesthetic will then be injected into your skin to make it numb. The epidural needle with then be inserted thought the numbed skin and slowly advanced into the epidural space using fluoroscopy (live X-rays) to guide the needle. When the needle enters the epidural space, it is common to feel either a cold sensation or increased pressure in your lower back, buttocks, and legs.

Once the needle is in the epidural space, a small amount of contrast will be injected under live X-ray to ensure that the medication will spread properly. You will feel increased pressure during this injection. After this, the corticosteroid will be slowly injected into the epidural space. Again, it is very common to feel increased pressure during this part of the procedure. If the pressure becomes too painful, you should let your surgeon know immediately. Once the injection is complete, the needle will be withdrawn and a dressing will be placed over the injection site.

Can I have sedation for the lumbar epidural steroid injection?

The vast majority of patients do not require sedation for the lumbar epidural steroid injection, however, we will provide light sedation for the procedure at your request. Patients who are receiving sedation must have a responsible adult with them to drive them home.

How soon can I go home after a lumbar epidural steroid injection?

Your blood pressure, pulse, and breathing will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home.

Can I drive myself or do I need a ride?

Most patients prefer to have a family member or friend drive them for their lumbar epidural steroid injection, however, you may drive yourself to the procedure as long as you are not requesting sedation.

How long will it take for the pain relief to take effect after the lumbar epidural steroid injection?

Some patients will experience immediate relief after the lumbar epidural steroid injection, however, it usually takes 24 to 72 hours for the effects of the steroid medication to take effect and it may be up to 1 week before the maximum benefits are achieved. Very often more than 1 injection is necessary to achieve a good level of pain relief.