Lumbar epidural steroid injections are a common procedure performed to alleviate low back pain and shooting leg pain. It involves a needle injection into the middle of the low back. This procedure is performed on an outpatient basis in a series of three injections spaced one week to one month apart for maximum effect. Many patients approach it with fears of paralysis and great pain because of stories heard from friends or family. Perhaps more knowledge of the lumbar epidural steroid injections may help ease anxiety and fear.
An explanation of the anatomy of the spinal column will help visualize the area of the injection. The spinal cord, which contains the nerves that control the body, are protected by 3 layers: the pia mater, arachnoid, and dura mater. Within these layers is the cerebral spinal fluid that provides nutrition to the spinal cord. Surrounding all of this is the bony cage of the spinal column. The epidural space is located between the bony cage and the dural mater.
To reach the epidural space, the needle is placed in the middle of the back and must pass through the skin, muscles, between the bones of the spinal column, and ligaments. Before the injection is performed, the skin of the back will be cleaned with an antiseptic to help prevent infections. The back will be anesthetized with a local anesthetic, usually lidocaine, but the anesthetic itself may cause stinging and burning. Sometimes it may be difficult to perform the injection because the epidural space is very small and narrow. Since the tip of the needle cannot be seen, the injection is performed by “feel” and the landmarks of the back. It is important to slouch the back towards the physician and to hold still for ease of injection.
The medication is a special form of steroid used for injections. Most people are familiar with cortisone shots and they are similar. Steroids are very good anti-inflammatory medicines and can help with swelling and irritation. The effects of the injection should be felt in about 3-5 days and last about 1-3 months. Nerve irritation of the spinal cord is felt to be a reason for low back pain and shooting leg pain. This can be caused by spinal stenosis squeezing the spinal cord, disc herniation hitting the spinal nerves, and spinal column arthritis. The steroids should calm the spinal nerves with its anti-inflammatory effects resulting in less back pain and shooting leg pain.
The complications of lumbar epidural steroid injection are related to the injection and to steroid effects. Bleeding, pain, headache, and infection can result from the injection. Weight gain, water retention, suppression of the immune system, and suppression of the body’s own natural steroids can result from steroid use. These considerations should be taken into account before any steroid injections.