Do Lumbar Epidural Steroid Injections Work for a Herniated Lumbar Disc?

A herniated disc is a degenerative disc disease in which a gel-like disc slips out of the space between the vertebrae into the spinal canal. This can press on spinal nerves nearby and can cause low back pain that can be severe and chronic. This most commonly happens in the back’s lumbar region and can cause hip and leg pain.

So do lumbar epidural steroid injections work for a herniated lumbar disc? Lumbar epidural steroid injection is an effective treatment for a herniated lumbar disc, lumbar spinal stenosis, and other spine conditions causing nerve and joint pain. It can help with chronic low back pain management for patients with recurrent disc herniations without needing surgery such as anterior cervical discectomy.

How Epidural Steroid Injection Works for Herniated Lumbar Disc

The spinal cord is a bundle of nerves running throughout the neck and back that helps the brain communicate with the rest of the body. From the spinal cord, spinal nerves emerge from their nerve roots to innervate the body.

In conditions such as a herniated lumbar disc, these spinal nerves surrounding the herniated disc can become inflamed and irritated. This causes nerve pain that can radiate into the hips and legs as radicular pain and cause discomfort, numbness, and tingling.

An epidural spinal injection is interventional chronic pain management caused by herniated lumbar disc. You’ll be injected with a potent anti-inflammatory medication into the epidural space, where the spinal nerves around the lumbar vertebrae are found in the lower back.

The lumbar epidural steroid injection acts on the affected nerves by reducing swelling and pressure from inflammation. It brings significant pain relief from lumbar disc herniation that lasts three months or more. It can relieve pain, numbness, muscle weakness, and tingling sensations from radicular pain felt in the legs caused by herniation and other conditions.

Medications used in epidural steroid injections may vary in volume and concentration in each patient. Your healthcare provider will assess the proper dosage for your treatment.

Preparing for an Epidural Steroid Injection

Your doctor may give you specific instructions to prepare for your ESI. Since the procedure is usually done with local anesthetics, your fasting guidelines from your doctor may not be strict or prohibitive.

Before the procedure, your doctor may also:

• Request for an MRI or CT scan of your back to assess and determine the area to be treated in your lower back
• Ask about the medications you’re currently taking and adjust their dosage, especially a blood thinner medications
• Ask if you’re pregnant because of the use of imaging during the procedure
• Advice you to have someone drive you home after your lumbar ESI

What Happens During an Epidural Steroid Injection?

Your lumbar epidural steroid injection (ESI) will be done in a hospital or an outpatient clinic. The procedure usually takes 15 to 30 minutes. The spinal injection is usually done by a pain physician trained in therapy or sports medicine.

Epidural injections may include pain medicine such as steroids, local anesthetics, and saline. Your doctor may use three routes for administering the infusion:

• Caudal epidural injection
• Interlaminar or translaminar epidural injection
• Transforaminal epidural injection

Based on the prior assessment, the doctor will choose the best method. The following is what happens during a lumbar epidural procedure:

• You’ll be asked to change into a medical gown and lie on your belly with a pillow under the abdomen.
• Your lower back will be thoroughly cleaned with antiseptic to minimize the risk of infection, especially where the injection will be done.
• The doctor may inject local anesthesia first near the era where the epidural will be done to minimize the pain you’ll feel during the injection of steroids.
• With the guidance of imaging like fluoroscopy X-ray, an epidural needle will be inserted into the epidural space where it’s needed.
• When the epidural needle is in place, a contrast media will be injected into the epidural space to help the doctor visualize better and ensure that the steroid will reach the target nerves.
• Afterward, the anti-inflammatory medication like steroids or corticosteroid injections will be slowly injected into the epidural space.
• The doctor will apply pressure on the site of your lower back once they’re done with the injection to avoid bleeding.
• They’ll clean the injection site and apply to dress after.
• Your doctor will ask you to move into a chair or bed and rest there for some time to monitor you for any reactions to the steroids given.
• You can go home once clear of any adverse reactions from the procedure.

Recovering from an Epidural Steroid Injection

Like any other procedure, recovering from an epidural steroid injection entails appropriately setting the expectations for the procedure, which include knowing how painful it is, its prognosis, its side effects, and the risk and complications associated with the procedure.

How Painful is a Lumbar Epidural Steroid Injection?

During the lumbar ESI, you may feel pressure as the epidural needle is inserted. You may also feel some stinging or burning during the injection. If the doctor gives you local anesthetics, the pain should be tolerable. Discomfort during the injection usually goes away after the procedure.

Prognosis of a Lumbar Epidural Steroid Injection

You may feel temporary pain relief immediately after the injection because of the local anesthetic. Expect the pain to return after a few hours because it will take some time for steroids to work once the anesthesia wears off its effect.

Your back may feel sore for a few days. You should rest and avoid heavy work for a few days after the lumbar ESI. You may be able to return to your daily activities after a few days, especially with the help of physical therapy.

It takes 1 to 5 days for the steroids to start to work. Once you feel its effect, your pain relief may last from several days to a few months or even longer. If your injection didn’t work for you, tell your doctor, and you may be advised to try another lumbar ESI.

Side Effects of a Lumbar Epidural Steroid Injection

Sometimes you may not feel anything during the injection. However, you may sometimes feel discomfort, pressure, tingling, burning sensation, or temporary pain on the injection site. These usually go away immediately.

If your doctor gave you local anesthetics, your legs might feel numb and heavy after. You may be able to walk and must be more careful when doing so. Follow the doctor’s instructions while you are being observed after the injection.

Other side effects include the following:

• Tenderness or bruising on the site of injection
• Increased blood sugar that can last for hours to several days
• Temporary high blood pressure and eye pressure

Risks and Complications of a Lumbar Epidural Steroid Injection

Generally, lumbar epidural steroid injections are safe. In rare cases, however, risks and complications happen, such as:

• Low blood pressure
• Severe headache from spinal fluid leakage
• Epidural abscess, discitis, osteomyelitis, or meningitis due to infection from the procedure
• Bleeding because of a damaged blood vessel during the injection
• Spinal cord nerve damage around the injection site
• Temporary urinary and fecal incontinence

Aside from these, ESIs are usually limited to patients 2 to 3 times a year. This is because of the risk of weakening bones of the spine or nearby muscles from high doses of steroid medication or a higher frequency of steroid administration.

When to Seek Consultation After Going Home from an ESI Procedure

You might seek consultation if your pain didn’t get any relief from the ESI procedure at all. The steroids medication may not work for everyone who undergoes the injection. Your doctor may advise another lumbar ESI procedure or route for pain relief.

It’s crucial to follow up with your doctor after the lumbar ESI procedure is vital. Have them reachable if you have questions or concerns, and follow the advice after treatment. Make a list of medicines and keep your test results for future use. Follow-up and physical therapy are essential to keep track of your treatment goals.

Best Pain Management Procedures at The Spine and Rehab Group

Lumbar epidural steroid injection is effective for chronic pain management for conditions such as a herniated lumbar disc. It relieves lower back and radicular pain and allows you to return to your daily routine after the treatment. Ask your doctor about the procedure for effective therapy for herniated discs.

Our experts at The Spine and Rehab Group provide the best pain management for herniated discs, spinal stenosis, and other conditions causing low back pain. To learn more about lumbar epidural steroid injection, cervical epidural steroid injections, and other treatments available for your back problems, book an appointment with us.