Lumbar Epidural Steroid Injections

Living with chronic pain can feel like an endless battle. For many, finding effective relief is a top priority. If you’re struggling with persistent lower back pain, lumbar epidural steroid injections (LESIs) might be the solution you’ve been seeking. In this article, we’ll explore how LESIs work, who they’re for, and what you can expect from the procedure. By the end, you’ll have a clear understanding of this treatment option and whether it’s right for you.

Understanding Lumbar Epidural Steroid Injections

Foraminal epidural steroid injections are a common and effective treatment for sciatica or radicular pain caused by a trapped nerve root. The procedure involves carefully injecting steroid and local anaesthetic into the epidural space surrounding the nerve root in the spinal canal, which helps to reduce inflammation and alleviate pain. Typically performed by a specialist, these injections can provide significant relief, particularly for those suffering from conditions like herniated discs, spinal stenosis, or sciatica. These injections are especially beneficial for individuals who haven’t found relief through other treatments such as physical therapy, oral medications, or lifestyle modifications. Although the relief is often permanent in 70% of patients, it can also provide a crucial window for patients to engage in rehabilitation exercises that further improve their condition.

What Conditions Foraminal Epidurals Treat

• Herniated discs or Disc Protrusion (slipped disc): This occurs when the softer protein centre of a spinal disc pushes through a crack (annular tear) in the tougher exterior fibrous annulus, potentially causing pain and nerve irritation. The disc nucleus is not liquid as is sometimes said but a white glycoprotein with a high water content designed to resist compressive forces.
• Spinal stenosis: This condition involves the narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Targeted foraminal epidurals at the level of the narrowing are very effective, particularly in older patients in whom the risks of open surgery may outweigh the benefits.
• Degenerative disc disease: With age or injury, the intervertebral discs can deteriorate, leading to back pain or referred leg pain. Positive result with a targeted foraminal epidural can confirm the diagnosis and give the chance to engage with physiotherapy to gain long term improvement. If this fails, sometimes a specialist may offer a lumbar spinal fusion.

By injecting steroid into the epidural space around the spinal nerves the body’s cycle of inflammation is given a large input of negative feedback to the production of biochemical inflammatory mediators. This is often sufficient to settle down a trapped nerve permanently without having to escalate to surgery to remove the disc protrusion or decompress the stenosis. Regular follow-ups with your surgeon or healthcare provider are important to monitor the effectiveness of the treatment and assess response. Complications or side effects are extremely rare when performed by a specialist.

How a Lumbar Epidural Steroid Injection is Performed

Understanding the procedure can help alleviate any concerns or fears. Here’s a step-by-step breakdown:

1. Preparation: You’ll lie face down on some comfortable pillows on the x-ray table, in the operating theatre, and the area around your lower back will be gently cleaned with antiseptic and a dose of local anaesthetic given.
2. Guidance: Using fluoroscopy (a type of X-ray), your doctor will guide a very thin needle (0.7mm in diameter!) into the epidural space. This is done at an oblique angle through the nerve exit path from the spinal canal, or foramen – hence the name foraminal epidural. This approach is much more controlled and comfortable than a traditional lumbar epidural performed for surgical anaesthesia or childbirth.
3. Injection: Once in position, a 2ml mixture of steroid (40mg Kenalog) and long-acting local anaesthetic (0.25% Chirocaine) is injected gently into the epidural space. This small volume of fluid very rarely causes any ill effects.

The entire process usually takes about 10- 20 minutes in the operating theatre, with the injection itself taking only a couple of minutes when performed by an expert. You’ll be monitored for a short time afterwards to ensure there are no immediate side effects and given a cup of tea and plenty of biscuits.

Short-Term and Long-Term Pain Relief

 Here’s what you can expect:

• Short-Term Relief: Many patients (but not all) experience immediate relief due to the anaesthetic component of the epidural injection. This relief can last for a few hours to a couple of days.
• Long-Term Relief: The steroid takes a bit longer to work and does the heavy lifting, often providing pain relief for several weeks to months, and sometimes years depending on the condition being treated. Some patients may need additional injections for sustained long term relief, giving sequential doses of anti-inflammatory action to achieve that goal with stepwise improvement. Your surgeon will review you at six weeks following your injection to assess your response and prognosis in detail. Sometimes escalation to surgical intervention is required at this stage and your surgeon will be happy to talk this through with you.

Possible Side Effects and Risks

Like any medical procedure, foraminal epidurals come with potential side effects and risks. While most patients tolerate the injections well, it’s important to be aware of possible complications:

• Temporary pain or bruising at the injection site
• Headaches
• Feeling faint or dizziness immediately afterwards
• Temporary numbness or weakness of the leg or “dead leg” sensation. This is due to the local anaesthetic affecting the nerve root.
• Neuropathic pain or injury (extremely rare)

Discussing these risks with your doctor beforehand can help you make an informed decision.

What to Expect Before, During, and After the Injection

Being well-prepared can make the lumbar epidural steroid injection experience smoother and less stressful. Here’s what to expect:

• Before: It is imperative to follow any instructions carefully, which includes taking your regular painkillers or stopping certain medications that could interfere with the procedure such as anticoagulants. Wearing comfortable clothing is advisable, as it will help you relax before and after the procedure. Additionally, arrange for someone to drive you home afterwards, as you may not be in a condition to drive yourself if you feel faint or have some numbness in your leg.
• During: The procedure is typically quick, often lasting no more than 15-20 minutes. You will be asked to lie still comfortably on your stomach during the procedure so please bear this in mind if you have difficulty with this due to pain. Extra painkillers at home before coming to hospital are a good option in this situation. While you may experience some deep pressure during the injection, most patients report minimal discomfort and are pleasantly surprised that it was not as bad as they thought it might be!
• After: Post-procedure care is crucial for optimal recovery. Rest for the remainder of the day and avoid strenuous activities to allow your body to heal. Follow your doctor’s recommendations for post-procedure care, which may include taking or restarting prescribed medications. Keep an eye on how you feel and report any unusual symptoms to your doctor promptly.

Other Treatment Options for Back and Leg Pain

Whilst foraminal epidurals can be highly effective, they’re not the only option available. Other treatments for chronic back and leg pain include:

• Physical Therapy: Exercises and stretches to improve strength and flexibility.
• Medications: Pain relievers and anti-inflammatory drugs or neural modulators.
• Surgery: In some cases, surgical intervention may be necessary.
• Alternative Therapies: Acupuncture, chiropractic care, and massage therapy can also provide relief.

Potential Benefits of Foraminal Epidural Steroid Injections

Lumbar epidural steroid injections offer a range of potential benefits for patients suffering from acute or chronic back and leg pain. Here are some of the key advantages:

• Pain Relief: One of the most significant benefits is their ability to provide relief from intense pain. The corticosteroid injected into the epidural space reduces inflammation around affected nerves, alleviating pain and making daily activities more manageable.
• Improved Mobility: By easing pain and discomfort, they can enhance your overall mobility. This can be particularly beneficial for those experiencing difficulty in walking, standing, or engaging in physical activities.
• Enhanced Physical Therapy Outcomes: Pain relief from foraminal epidurals can make it easier to participate in physical therapy, which is crucial for long-term recovery. With reduced pain, patients are more likely to follow through with their therapy programmes, improving strength and flexibility.
• Reduced Need for Medications: By targeting inflammation directly at the source, LESIs can decrease reliance on oral pain medications, which often come with undesirable side effects such as drowsiness or gastrointestinal issues.
• Minimally Invasive: Compared to surgical options, they are minimally invasive with a lower risk of complications. The procedure is quick, typically performed in a daycase setting, and requires minimal recovery time.
• Potential for Long-Term Relief: While individual results can vary, many patients experience significant pain relief that lasts for several weeks or even months following a successful injection. This long-term relief can improve overall quality of life and get you back to sporting activities. 70% of patients with a slipped disc and a trapped nerve obtain permanent benefit from a foraminal epidural injection.

Understanding these potential benefits can help patients make informed decisions about incorporating spinal injections into their back and leg pain management plans. Always consult with your doctor or healthcare provider to discuss the suitability of this treatment based on your specific condition and medical history, with onward referral to a specialist.

Summary of Lumbar Epidural Steroid Injections

As spinal experts we would be very happy to see you and discuss this straightforward treatment with you. Here at SpineArt we perform around 400 injections each year with excellent results.

For more information and to explore other of our pain management options, visit Spine Art or contact us directly at Spine Art Contact. Your path to pain relief could begin with just one click.

Living with chronic pain doesn’t have to be your reality. With the right treatments and support, you can reclaim your life and enjoy the activities you love once more.