hi I'm Dr. John Shim and today I want to talk about lumbar epidural steroid injections. Many of you have had this recommendation already made by your doctors. So what really is an epidural injection? To make it very simple basically you take a small needle you place it through the skin and then the needle is placed right next to the nerves that come out of your lower back. I like to put the needle and what's called a transforaminal location. The needle was placed slightly outside the hole where the nerves come out of the spine called the foramen when you place that needle it has to be put in a very careful position the needle can't go too deep where it will cause the irritation of the nerve it has to go deep enough so the medicine will bathe the nerve. Now the medicine use is a steroid. Steroids decrease the inflammation. When you have a nerve pain at the transforaminal level or at the epidural space a lot of times is caused by a chemical spill caused by a disc herniation the steroid medications help mop up or decrease the inflammation caused by this chemical spill. That's why the epidural injections can and often do work. Understand that the epidural injections is a multi-step process: first the skin is cleansed then we use x-ray guidance to make sure we have the needle placed in the proper location for the nerve that's irritated. I use something called a transforaminal approach; that means the needle is placed through the skin through the muscles through the fascia and just place just to the outside of the facet joint and passing into the space called the foramen. In that foramen you have to be careful not to put the needle too deep because, you'll pierce the nerve. You also have to be careful not to place the needle into small blood vessels that surround the nerve because that can cause a different set of problems. Once the needle is placed that needle is aspirated, or drawn back to make sure it's not actually in the wrong location, then the steroid medication is delivered onto the nerve. With time, with the steroids the inflammation that nerve will decrease and there'll be less leg or back pain. The epidural injections is a very useful and at times very effective means to manage leg pain caused by nerve irritation. Understand however there are certain risks so if your doctor hasn't discussed them with you make sure number one you're off all blood thinners and off all anti-inflammatory agents. That small blood vessel that we talked about you don't want that to continue to bleed if you accidentally pierce it. Number two if you're diabetic steroid medications can cause a significant flare-up of your blood sugars and may actually cause you to have some sort of diabetic crisis. And number three understand that at times even though it's not the intention of the procedure you can have a flare-up of leg pain or back pain just by the procedure itself. In general I'd say about 85% of the time people feel better with the epidural steroid injection It doesn't work for everybody but when it works it definitely helps you get better faster. This is Dr. Shim talking about lumbar epidural steroid injections. I hope this information was useful to you. Thank you.
In our practice, we use Epidural Steroid Injections for both treatment as well as diagnostic purposes. The research for these injections have been significant, but the conclusions by the various authors have been very different. There continues to be controversy on the efficacy of the treatments, including the side effects versus the results.
Traditionally, epidural steroid injections have been seen as a reasonable treatment option for patients with back pain and sciatica. Based on research and experience, we use epidural steroid injections when a patient has a sciatic, or nerve inflammatory complaint.
Epidural steroid injections benefit the patient by delivering corticosteroids to the areas of inflammation. The steroids have a known anti-inflammatory effect and will decrease the swelling to the tissues upon contact. In a very simplistic way, by decreasing the inflammation, the affected nerves in the spine will be less irritated and therefore cause less pain.
Some practitioners also inject a volume of saline associated with the steroids and theorize that the volume of saline also flushes the area of painful chemicals that also lead to the inflammation.
For diagnostic purposes, if the epidural steroid injections give even temporary relief, it usually confirms that there is an irritant to certain nerves. Based on temporary improvement, surgeons may consider the patient an appropriate candidate for surgery, as many practitioners use the so called transforaminal technique to try to isolate the specific nerve that may be causing the irritation.
There are certainly risks to the procedure, such as increased blood sugar, possible bleeding or infection, possible nerve injury. They should always be done with x-ray guidance and any blood thinners or anti-inflammatories must be stopped at least 5 days before the injection.
- Lewandrowski KU. Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection. Clin Neurol Neurosurg. 2018 Jul 24;173:38-45. PubMed PMID: 30075346