Lumbar Epidural steroid injection

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The epidural space is located along the spinal canal, one layer before the spinal fluid which contains a combination of fat and blood vessels. It is in close proximity to the spinal cord, nerves, and discs. Medications such as steroids and local anesthetic are injected via a small needle which can assist with decreasing pain by decreasing inflammation and swelling. This may reduce the pain, tingling, numbness, and other symptoms. 

An interlaminar injection places a needle centrally between the bones. The benefit to this can be that medication will spread to both sides with only one needle placement. However, if you have had prior back surgery or if the narrowing is very severe, it might not be possible to place the needle through this method. A transforaminal injection places the needle tip off to the side closer to where the nerves exit and travel down the leg (This procedure is not typically done in the neck). This option may be select if your pain only impacts one side or your spinal anatomy precludes the other approach. Regardless, both injections have the same end goal of placing a small needle into the epidural space in proximity to the suspected pain generator. A review of your pain symptoms and your MRI/CT scan will allow for discussion on the best option for you. 

Epidural steroid injections are used to treat conditions that affect the spine from the neck to the lower back. These conditions include herniated discs, protruding discs, degenerated disc, and spinal stenosis (narrowing) or scar tissue or other changes following neck or lower back surgery. It can help with symptoms of pain in the neck, shoulder, middle or low back, arms, or legs. On some occasions it can also improve numbness or weakness in the extremities.

The risks of the injection is generally low, but can include the following; infection, bleeding, bleeding inside the epidural space, nerve damage/irritation and worsening of your symptoms. It is also possible the procedure does not offer any improvement in pain symptoms. Patients with diabetes may notice an increase in their blood sugar and should monitor this closely. Another side effect includes water retention. If you are on any blood thinners/Aspirin/Plavix, have diabetes, or any active infection you should notify your doctor.  

You may notice that your pain may be gone or quite less shortly after the injection though more commonly you will experience decreased pain in 24-72 hours. For some, it can take up to a couple weeks for the full effect of the medication. The duration of relief varies between different people though generally relief can be 3-6 months. For some the relief is shorter and others the relief can be considerably longer. While pain is reduced it is important to continue with physical therapy for long term health and wellbeing.

Physical therapy and rehabilitation is essential in treating many patients with spinal conditions. By making the muscles around the spine stronger and improving flexibility, stress on the neck and back can be decreased. One of the major goals of the epidural steroid injection is to reduce pain and allow the patient to participate more effectively in physical therapy.  

If you do not receive benefit from the first epidural injection, it is reasonable to try a second as pain location can be multifactorial and your doctor can try a different location, approach, or medication. If a series of injections do not offer any improvement, the pain could be from an alternative source. There are other medications or procedures that could be considered. You may also benefit from more advanced pain therapy techniques such as spinal cord stimulation or a surgical consultation