What is a Lumbar Epidural Injection?

A lumbar epidural injection is a minimally-invasive procedure that consists of a physician injecting a mixture of corticosteroids (e.g. dexamethasone or triamcinolone) and anesthetic medications (e.g. lidocaine) into the epidural space of the lumbar spine. The epidural space is a fat-filled area between the vertebrae of the lumbar spine and the dura, a protective sac that encases the spinal cord. This combination of medications has two healing effects: the anesthetic delivers immediate pain relief by numbing the direct area in pain, and the corticosteroids help control the inflammation that is impinging the spinal cord or the network of nerves that branch off of it to the extremities. The goal of a lumbar epidural injection is to reduce pain so that you can go about your normal life. However, the positive effects of the procedure will not last forever, so it is commonly used in combination with other treatment modalities, like physical therapy, which can be made easier with the pain relief generated by these injections. In addition to serving as a front-line treatment, lumbar epidural injections also prove useful in determining whether or not surgery or other more invasive treatment would be successful in treating your back pain.

Who is a candidate?

If you are experiencing significant low back, hip, buttocks and/or leg pain, you could be a candidate for a lumbar epidural injection. Specifically, studies have shown that patients who suffer from stenosis of the lumbar spine, spondylolisthesis of the lumbar spine, herniated discs, degenerative disc disease, and sciatica have a high likelihood of benefitting from lumbar epidural injections. Lumbar epidural injections have also proven helpful for patients with certain painful inflammatory conditions of the spine. However, it may not be safe for people with certain conditions—like infection, diabetes, blood clotting disorders, or glaucoma—to undergo lumbar epidural injections, as the medications and the injection itself could cause adverse reactions. Therefore, consult a pain management physician to help determine whether or not a lumbar epidural injection is right for you.

What happens during a lumbar epidural injection?

A lumbar epidural injection is generally performed under x-ray or fluoroscopic guidance, which allows the physician to precisely guide the needle to the exact spot in the epidural space where they want to inject the medication. During the procedure, patients will be given a mild sedative and local anesthetic will be applied to the injection site so that the procedure itself is not painful. Using imaging guidance, your physician will guide a needle through your back and into the epidural space, where they will deliver a dose of local anesthetic and corticosteroids to reduce pain and control inflammation. The procedure takes less than thirty minutes and, after a brief period of observed recovery, you are free to go home. While the numbing aspect of the local anesthetic will often provide immediate pain relief, the steroids, which provide longer-lasting benefits, can take two to five days to start taking effect.

What happens after a lumbar epidural injection?

Following the injection, you will likely feel immediate pain relief from the local anesthetic injected alongside the corticosteroids. However, this relief will fade once the anesthetic wears off, and the steroids don’t generally take effect for two to five days, so you may experience a pain relapse. In some cases, the pain can actually worsen in the one to three days following the procedure before the steroids take effect. If this happens to you, don’t get discouraged; lumbar epidural injections simply take time to really make an impact. In conjunction with complementary treatments like physical therapy, massage, and non-opioid pain medications, many patients go on to live pain-free lives following a lumbar epidural injection.

Are there any risks?

Lumbar epidural injections are generally regarded as safe, as serious side effects are very rare; however, like any minimally-invasive treatment, there are potential risks associated with the procedure. Potential side effects include infection; dural puncture, which can cause spinal fluid to leak out of the dura and trigger a painful spinal headache; bleeding; and nerve damage. In addition to the risks associated with the procedure itself, there are also some potential side effects to the medications being injected. Corticosteroids can cause headaches, fever, sleeplessness and increased pain at the site of injection. As with the procedural risks, these complications are very rare and will generally resolve quickly even if they arise.