Lumbar Epidural Steroid Injections 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 (CSF)
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. Overall, these are safe
injections and performed every day by qualified physicians without
complications. |