Epidural Steroid Injections

The use of spinal injections to treat low back was first documented in 1901. Then in 1952, epidural steroid injections were introduced for low back pain with associated sciatica (pain in the sciatic nerve due to lumbar disc herniation). Today, epidural steroid injections are an integral part of non-surgical management of low back pain.

Several common conditions, including lumbar disc herniation, degenerative disc disease and lumbar spinal stenosis, can cause severe acute or chronic low back pain and/or leg pain. For these and other conditions, an epidural steroid injection may be an effective non-surgical treatment option. While the effects of the injection tend to be temporary (relief from pain for one week up to one year), an epidural can be very beneficial for patients during an episode of severe back pain and provide enough relief to allow the patient to progress with their rehabilitation program.

An epidural is an injection that delivers steroids directly into the epidural space within the spine. This space is the area between the dura mater (a membrane) and the vertebral wall, and is filled with fat and small blood vessels. It is located just outside the dural sac, which surrounds the nerve roots and cerebrospinal fluid (the fluid nerve roots are bathed in). Sometimes a flushing solution (either lidocaine or normal saline) is also used to help flush out inflammatory proteins which may be the source of pain.

The procedure usually takes between 15 and 30 minutes with the patient laying flat on their abdomen on an X-ray table. The skin is numbed with lidocaine prior to the injection. Then, using fluoroscopy for guidance, the physician directs a needle toward the epidural space. Once the needle is in the exact position, the epidural steroid solution is injected. The patient is then monitored for 15 to 20 minutes before being discharged.