Lumbar Epidural Steroid Injection
A Lumbar Epidural Steroid Injection (LESI) is a minimally invasive procedure used to alleviate pain and inflammation in the lower back caused by conditions such as herniated discs, spinal stenosis, or sciatica. The procedure involves injecting a corticosteroid medication directly into the epidural space of the lumbar spine, which surrounds the spinal cord and nerves. The steroid reduces inflammation and swelling around the irritated nerves, providing significant pain relief.
This treatment is often recommended for patients who experience persistent lower back pain that radiates to the legs and have not found relief through conservative treatments such as physical therapy, medications, or rest.
About the Procedure:
Lumbar Epidural Steroid Injections (ESIs) are a common treatment for lower back pain, sciatica, or nerve pain caused by conditions like herniated discs or spinal stenosis. These injections deliver a combination of anti-inflammatory medication (steroids) and sometimes a numbing agent directly into the epidural space around the spine to reduce swelling and pain.
There are
Four main ways
these injections can be performed, each targeting the affected area in a slightly different way:
1. Interlaminar ESI (Straight in the Middle):
How It Works:
This method involves placing the needle in the middle of your back between the bones (called the laminae) to deliver medication into the epidural space.
Best For: Generalized lower back pain or pain that spreads across multiple areas of the spine.
What You’ll Feel: You may feel slight pressure as the needle is inserted, but the goal is to deliver relief across a broader area of your lower back.
2. Transforaminal ESI (Targeting the Nerve):
This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. The injection takes only a few minutes to complete.
3. Caudal ESI (Near the Tailbone):
This outpatient procedure is an injection of a steroid-anesthetic medication through an opening in the sacrum. The medication can reduce swelling and inflammation of irritated spinal nerves. The injection takes only a few minutes to complete.
4. Thoracic Epidural Injection (Upper to Middle Back)
A shot that helps ease pain for a short time. It's done to treat the upper to middle part of your back (thoracic region). Medicine is injected into the epidural space. This is the area around your spinal cord.
Sometimes, nerves that branch off the spinal cord can become pinched or inflamed. That might happen if part of an intervertebral disk presses into the space of the spinal cord and nerves. This can happen if a disk is damaged and part of it leaks and bulges. You may then feel pain in your back.
What to Expect for the Treatment?
The Lumbar Epidural Steroid Injection is an outpatient procedure that typically takes 15-30 minutes to complete. Patients may receive a mild sedative to help them relax, but the procedure is usually performed under local anesthesia.
The doctor begins by positioning the patient face down on an examination table. Using imaging guidance such as fluoroscopy (live X-ray), the doctor precisely inserts a needle into the epidural space in the lower back. Once the needle is correctly placed, the steroid medication, sometimes combined with a local anesthetic, is injected into the area surrounding the irritated nerves. The patient may feel some pressure during the injection, but it is generally not painful.
After the injection, patients are monitored for a short time to ensure there are no immediate reactions, and they can typically go home the same day. It’s common for patients to feel some relief within a few days, although it may take up to a week for the full effects to be noticeable.
Recovery and Post-Treatment Care:
Following the procedure, patients are advised to take it easy for the rest of the day but can usually resume light activities the following day. Heavy lifting, strenuous exercise, and any activity that puts excessive strain on the back should be avoided for a few days. Some patients may require a series of injections spaced several weeks apart for optimal results.
The effects of the injection can last from several weeks to a few months, depending on the individual’s condition and response to the steroid. While this treatment may not cure the underlying cause of the pain, it can significantly improve symptoms and allow patients to engage in physical therapy or other rehabilitation methods that address the root issue.
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