Lumbar Steroid Injections

Epidural glucocorticoid injections are commonly given to patients with leg and/or back pain to relieve such pain and improve mobility without surgery. These steroid injections buy time to allow healing to occur and/or as an attempt to avoid surgery after other conservative (non-surgical) treatment approaches have failed.

During a transforaminal injection, a small-gauge blunt needle is inserted into the epidural space through the bony opening of the exiting nerve root.

The needle is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their belly using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. A radiopaque dye is injected to enhance the fluoroscopic images and to confirm that the needle is properly placed. This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.

Spinal Conditions Treated and Outcomes

Indications include large disc herniations, foraminal stenosis, and lateral disc herniations. Patients with disc herniations and leg pain in most of the studies attained maximal improvement in 6 weeks. Interestingly, long-term success rates for transforaminal epidural glucocorticoid injections ranged from 71% to 84%.

Is More than One Injection Necessary?

As a rule, patients who obtained little relief from the first injection got little benefit from a second or third injection. Those patients with degenerative lumbar canal stenosis and patients who failed previous therapies may significantly improve standing and walking tolerance following transforaminal lumbar steroid injections. However, only about 15% to 61% of interventional pain management physicians perform transforaminal epidural injections. Interestingly, almost every single interventional pain management physician uses the conventional, interlaminar epidural injection.

Complications of Lumbar Steroid Injections

Complications are rare but may include headaches, infections, blood pressure changes, bleeding, and discomfort at needle insertion site. Use of steroids rarely causes an increase in blood sugar and blood pressure, as well as leg swelling. The major complication, that being damage to a nerve root is very rare. However, using a blunt needle may even more reduce the risk of this complication.

Patient Sedated but Awake

The patient is sedated but awake through the intervention. It is important that the physician and patient communicate during the procedure. If significant leg pain is triggered during placement of the epidural needle or injection of the medication, the physician will immediately stop the procedure and check the position of the needle and the source of pain.

Epidural Injections can be a very helpful adjunct in rehabilitation of patient's the spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk. They work by placing cortisone (a potent anti-inflammatory medication) close to an inflamed nerve. This allows the patient to be fully able to regain full motion and increase the muscular support of the spine critical in the recovery and prevention of future episodes.

They are generally not indicated in spine pain that does NOT radiate from an irritated spinal nerve. Most patients actually respond to just 1-2 injections; therefore, they should not be routinely performed in a "series of three". Generally, 60% of patients require only one injection and only 10-20% will require 3 injections. Certainly, if there is little or no pain relief after trying 2 injections, it is unlikely that the third injection will be of benefit. In addition, most patients can be treated with a local anesthetic without the need for sedation which requires an IV and a longer recovery immediately after the procedure.

Epidural injections can be done at any level of the spine: cervical (neck), thoracic (mid-back), lumbar (low back), and sacral (tailbone area). The thoracic epidural may be a valuable tool in the treatment of mid-back and chest wall pains. These problems might be caused by disc problems, arthritis of the spine, or even shingles.