Lumbar Epidural Steroid Injection

• Purpose – To reduce lower back pain, and pain, tingling or numbness radiating into the legs.

• Procedure Overview – There is a membrane covering the nerve roots in the spine called the dura.  Nerves travel through the epidural space outside of the dura.  The injection puts medication in the epidural space to reduce inflammation around the nerves.

• Procedure Details – There are three techniques used for this injection – interlaminar, transforaminal, and caudal.  For all three the patient is lying on their stomach.  A fluoroscopy machine (x-ray) is used to view the spine, and needle.  There are usually two pinches, the first is for the local anesthetic to numb the area, and the second is the injection needle.  A contrast dye is injected to confirm the location before the steroid solution is injected.  There may be moderate pressure on the skin during the injection which takes about  5-10 minutes.  The interlaminar approach is the quickest, and usually the most well tolerated, but the medication is a little farther from the target area. The transforaminal technique is closest to the nerve and therefore most likely to give relief, but also more likely to cause a brief sharp shooting pain into the leg.  The caudal approach is through a space in the bottom of the tailbone.

• Before the Procedure – The patient should arrive 15 minutes prior to the scheduled appointment for preparation.  This involves a blood pressure check, consent forms and if needed, application of a hospital gown.  An anti-anxiety medication may be given if needed.  The patient will need a driver to bring them to and from the visit.  Blood thinners should be held from 5-7 days prior to the injection.  This would include non-steroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen), aspirin, Plavix, Effient, warfarin, and Pradaxa.

• After the Procedure – The staff will check vitals, and ensure there are no ill effects before discharge home.  If the area is sore you can apply ice for 20 minutes per hour until soreness is reduced.  A small percentage of the time pain may increase for a few days before it gets better.