Epidural Cortisone Injections
Epidural injections are a non-surgical treatment option for low back (lumbar) pain and pain radiating into the legs. The procedure involves delivering pain relieving medications directly to or near the source of the pain in the spine during a short outpatient procedure. Epidural injections can be very effective for some people and may be repeated over time. For some, physical rehabilitation is possible once the pain has been relieved.
The lumbar area of your spine is located in your lower back and forms the curve below your waist. Five large bones (vertebrae) make up the lumbar spine. A disc between each bone allows movement and acts as a shock absorber. The opening in the center of each bone forms the spinal canal.
Your spinal cord is located within the protective spinal canal. The spinal cord extends from the brain and is a major part of your nervous system. The spinal cord does not fill the entire space in the spinal canal. Instead, the spinal cord is surrounded by the epidural space (cavity), which contains tissue, nerves, and blood vessels.
Spinal nerves extending from the spinal cord travel out of the lumbar spine to the lower back, buttocks, legs, and feet. The spinal cord and nerves at the lumbar spine level send signals for sensation and movement between your brain and lower body muscles. The spinal cord tapers near the first lumbar vertebra and forms a group of nerves called the cauda equina. The cauda equina is involved with regulating bowel and bladder functions.
Lumbar epidural injections are used to treat pain from ruptured discs, cysts, arthritis, fractures, cancer, shingles (post herpetic neuralgia) or other changes in the spine that cause nerve irritation and pain. Spinal stenosis is a condition that causes the spinal canal to narrow and put pressure on the spinal cord and nerves. Compressed, pinched, or irritated nerves in the lumbar spine can cause sciatica. This condition causes pain that can extend from the low back, through the buttocks and legs, and down to the feet. In addition, lumbar epidurals are used to treat cancer-related pain.
The type of symptoms that you experience depends on the cause of your low back pain. Your pain may spread (radicular pain) to your buttocks, legs, and feet. You may experience stiffness, weakness, numbness, or tingling. If you experience a loss of bowel or bladder control, you should seek medical attention immediately.
Your doctor will examine you and conduct tests to determine the cause of your low back pain. Imaging tests, lab tests, and nerve studies may be used to provide your doctor with more information. Your doctor will let you know if epidural injections are a treatment option for you.
Epidural injections administer local anesthetic and/or steroids into the epidural space. Steroid medication is used to reduce swelling and inflammation. A salt water (saline) solution may be added to flush chemicals that cause inflammation. Short or long acting anesthetic medications are used to relieve pain. The various pain syndromes include lumbar radiculopathy, spinal stenosis, arthritis, cancer related pain and neuropathy.
Epidural injections are short outpatient procedures that can be given at a surgery center, hospital, or your doctor’s clinic. You will wear a gown for the procedure. You will be positioned sitting up or lying on your side or stomach. Before you receive the epidural injection, your lower back area will be sterilized, and numbed with an anesthetic. You may receive a relaxing medication before your procedure begins.
Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide the needle to the epidural space. A contrast dye is used to confirm the needle placement. A hypoallergenic dye is necessary for patients with allergies to shellfish or iodine dye. Next, the medication solution is delivered to the epidural space, and the needle is removed.
You will be monitored for several minutes before you can return home. Your doctor will instruct you on how to relieve temporary mild pain at the injection site. Most people can resume their regular activities the next day.