Lumbar Epidural Spinal Injection
Disc Herniation & Stenosis Treatment
What is a lumbar epidural spinal injection?
A lumbar epidural injection is a very common procedure where a mixture of local anaesthetic and steroid (anti-inflammatory) is injected around swollen or compressed nerves in the lower back, to help relieve the pain and inflammation of nerve pain. An epidural injection can also be used to treat lower back pain.
The epidural space is an anatomical area within the spinal canal that contains fat. The space is outside the fluid-filled sac which contains all of the nerves which go to your legs. This sac is called dura or thecal sac. An epidural injection injects local anaesthetic and steroid into this epidural space. The local anaesthetic numbs the nerves whilst the steroid reduces inflammation - both aim to decrease your pain.
Nerve pain and inflammation is most commonly due to compression from a disc herniation (disc prolapse) or stenosis. This is typically due to disc degeneration, or “wear and tear,” in the spine. Epidural injections are commonly performed in the lower back, or lumbar spine, to treat radiating leg pain, known as sciatica, or pain in the legs when walking (neurogenic claudication). Epidural injections can also provide pain relief in patients suffering from chronic lower back pain.
If sciatica pain or nerve pain cannot be controlled with pain medications then a trial of an epidural injection (steroid injection) is a very appropriate and highly recommended treatment option. It is a very safe procedure that may help improve painful symptoms. The procedure is typically performed under CT guidance by a radiologist, or by a pain physician under sedation with the aid of an x-ray.
What is a lumbar epidural spinal injection?
A lumbar epidural injection is a very common procedure where a mixture of local anaesthetic and steroid (anti-inflammatory) is injected around swollen or compressed nerves in the lower back, to help relieve the pain and inflammation of nerve pain. An epidural injection can also be used to treat lower back pain.
The epidural space is an anatomical area within the spinal canal that contains fat. The space is outside the fluid-filled sac which contains all of the nerves which go to your legs. This sac is called dura or thecal sac. An epidural injection injects local anaesthetic and steroid into this epidural space. The local anaesthetic numbs the nerves whilst the steroid reduces inflammation - both aim to decrease your pain.
Nerve pain and inflammation is most commonly due to compression from a disc herniation (disc prolapse) or stenosis. This is typically due to disc degeneration, or “wear and tear,” in the spine. Epidural injections are commonly performed in the lower back, or lumbar spine, to treat radiating leg pain, known as sciatica, or pain in the legs when walking (neurogenic claudication). Epidural injections can also provide pain relief in patients suffering from chronic lower back pain.
If sciatica pain or nerve pain cannot be controlled with pain medications then a trial of an epidural injection (steroid injection) is a very appropriate and highly recommended treatment option. It is a very safe procedure that may help improve painful symptoms. The procedure is typically performed under CT guidance by a radiologist, or by a pain physician under sedation with the aid of an x-ray.
Epidural Injection Video
Why does Dr Oehme recommend an epidural injection?
In the cascade of treatment for sciatica and other nerve root compressive problems, such as radiculopathy or stenosis, following failure of medications to control the pain, an epidural injection is a safe and simple treatment that may help relieve the symptoms of nerve pain.
The injection of local anaesthetic and steroid reduces the inflammation in the nerve to help with pain. In most patients with disc prolapse, stenosis or back pain, it is worthwhile trying an epidural injection prior to consideration for surgery. If the epidural injection helps control the pain, surgery may be avoided or delayed. In addition, if the epidural injection does help, it is diagnostic that the compressed nerve is the symptomatic level, and is predictive of a good response to surgery.
What happens during an epidural injection?
Most epidural injections are performed by a radiologist under CT guidance. These are routinely performed at most radiology facilities. Epidural injections are also commonly performed by pain specialists.
The patient lays face down on the CT scanner or x-ray table. The procedure is performed as a sterile procedure to reduce the chance of infection. A small amount of local anaesthetic is injected into the skin so that the needle passes through without causing any pain. A radiologist or pain physician who specialises in the procedure performs the injection.
A needle is advanced under CT or x-ray guidance around the compressed nerve root. Once the position of the needle is confirmed with CT or x-ray to be in the epidural space, a small mixture of local anaesthetic and steroid is injected around the nerves. The local anaesthetic numbs the nerve whilst the steroid reduces inflammation. The needle is removed following the injection and the patient is able to mobilise.
Dr Oehme will advise if an epidural injection is appropriate for you at your consultation. His rooms will also book the procedure at an experienced radiology facility. For more information about epidural injections watch the video above.
What are the risks of having a nerve root injection?
Most epidural injections are performed very safely and most patients have minimal side effects. The most common complication is to have some discomfort around where the needle passes. This usually resolves over the course of a day or so.
Often the nerve pain or back pain will disappear almost immediately after the injection, if it has been successful. Sometimes, however, it does take a couple of days for the inflammation in the nerves to subside. In a small percentage of patients the epidural injection may have no clinical benefit. Although this is frustrating for patients, it is helpful information for the surgeon as it may indicate the nerve pain is due to another cause or another spinal level.
It is common to get tingling in the lower legs following the injection. Other rare complications including infection, bleeding, bleeding causing haematoma requiring surgery, back pain, or rarely, neurological injury.
What factors may prevent me from having this procedure?
Factors which may preclude you from having an epidural injection include:
1. If you are taking blood thinning medications such as aspirin, Plavix or Warfarin.
2. If you have allergy to contrast material.
3. Abnormal spinal anatomy
4. Morbid obesity
What happens after the procedure?
Patients are usually asked that someone else will drive them home from the injection. You are able to walk almost immediately after the procedure. It is also advisable that you should not perform any strenuous exercise for a period of one to two days after the injection.
How long do epidural injections provide symptom relief?
The response of patients to epidural injections is variable. A small percentage of patients will have no benefit from the procedure. Most patients will have benefit that lasts somewhere between two weeks to two months. Some patients will get longer lasting relief from the procedure.
If pain returns, one option is to have another epidural injection. The second option is to consider surgery to decompress the nerves. If you have any doubt, Dr Oehme will advise you if having an epidural injection is an appropriate treatment.
Who performs nerve root injections?
Dr Oehme will recommend epidural injections to many patients prior to consideration for surgery to see if they settle nerve pain. Dr Oehme does not perform the procedures himself, but will refer you to either a specialist radiologist who performs the procedure under CT guidance, or to a pain physician who performs the injection under sedation with x-ray guidance.
Dr Oehme will advise if an epidural injection is an appropriate for your spinal condition. For more information or to arrange a time to discuss surgery with Dr Oehme contact Keyhole Neurosurgery on 1800 DO SPINE (1800 367 746).