Lumbar Epidural Steroid Injections for Lower Back Pain
Content
- Lumbar Epidural Steroid Injections for Back Pain
- What is a Lumbar Epidural Steroid Injection (ESI)?
- What Conditions Can a Lumbar ESI Treat?
- Preparations Before a Lumbar ESI
- What Happens During a Lumbar ESI Procedure?
- What Happens After a Lumbar ESI Procedure?
- Possible Risks and Complications from a Lumbar ESI
- Frequently Asked Questions
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What is a Lumbar Epidural Steroid Injection (ESI)?
A lumbar epidural steroid injection (ESI) involves directly injecting a medication (in this case, corticosteroids, also known as steroids) into the epidural space of your lower back. This epidural space is the fat-filled area surrounding your spinal cord and nerves. The procedure is performed to provide short-term relief of symptoms from a back injury or irritation, swelling, or inflammation of the spinal nerves.
An ESI typically consists of a local anaesthetic to ensure your comfort during the procedure, and a steroid medication for treating your lower back pain symptoms. The effects vary and may last for several weeks or months and will require follow-up injections for continued symptom relief.
What Conditions Can a Lumbar Epidural Steroid Injection (ESI) Treat?
An ESI may provide temporary symptom relief by treating the root cause of your lower back pain, including:
- Lumbar herniated discs
- Degenerative disc disease
- Axial back pain
- Joint cysts
- Bone spurs that apply pressure on nearby nerves
- Spinal stenosis (narrowing of lumbar spine nerve spaces, which places pressure on the nerves)
- Spinal nerve compression while standing or moving (also spinal stenosis)
- Sciatica
- Osteoarthritis of the spine
As lower back pain can have different underlying causes, assessment by a back pain specialist may help determine the source of the symptoms and whether treatments such as a lumbar epidural steroid injection may be appropriate.
Preparations Before a Lumbar Epidural Steroid Injection (ESI)
Before receiving a lumbar ESI, your doctor will first evaluate if you are an eligible candidate for the treatment. You may need to disclose the medications you are currently taking and whether you are pregnant or have an underlying allergy or health condition, as these can greatly influence your eligibility for receiving lumbar ESIs. You may also be asked questions about your overall health, whether you have had previous hospital stays, and more.
Note that you may not be suitable for a lumbar ESI if you have:
- Previously received a steroid injection in the past three months, or four steroid injections within the last year.
- A scheduled vaccination is soon, or one was received recently.
- Certain health conditions, such as diabetes or high blood pressure.
- An existing infection.
If you are eligible to receive lumbar ESIs, you may need to follow specific instructions provided by your doctor to prepare for the injection. This may include:
- Fast for at least six hours (or as indicated by the doctor) before the procedure. You can and should continue to stay hydrated with clean water.
- Avoid taking blood thinners or similar medications until your doctor says you may resume your medication schedule.
- Arrange for transportation to and from the clinic or hospital. Avoid driving on your own, as the sedation can make you feel sleepy.
- Take a bath or shower before the procedure, but avoid applying lotions, perfumes, deodorants, or nail polish.
Your doctor may also perform an MRI or CT scan of your lower back before your lumbar ESI to determine the injection site and ensure an accurate delivery of steroids to the affected area. You can also take the time to ask our doctors any relevant questions about the procedure to ease any doubts or concerns you may have.
What Happens During a Lumbar Epidural Steroid Injection (ESI) Procedure?
A lumbar ESI procedure typically takes 15 to 30 minutes to complete. There are three ways that a doctor can perform a lumbar ESI:
- Interlaminar ESI: For disc herniation, spinal stenosis, and axial lower back pain, the doctor may inject steroids between two laminae (the bony plates on each vertebra that protect the spinal cord) to reach the epidural space.
- Transforaminal ESI: This injection goes through the foramina, the openings that allow nerve roots to exit the spinal cord. It is performed to treat radicular pain from a disc herniation or a specific injury to individual nerve roots.
- Caudal ESI: This ESI is used to treat persistent leg or low back pain (or both) after surgery. It is delivered close to the sacrum (the triangular bone in your lower back between the hip bones), where the steroids may reach the lowest spinal nerves.
When you are ready, you will be asked to lie face down on a medical table. You may be given a sedative to help you relax throughout the procedure. Next, your doctor will thoroughly clean the injection site on your lower back with an antiseptic solution while preparing sterile sheets around the area. They may also inject local anaesthesia near the injection site to numb the discomfort when you receive the injection.
Subsequently, the doctor will use prior imaging scans or X-ray guidance with a contrast dye (or both) to ensure an accurate injection. Once the injection is confirmed safe to proceed, the doctor will slowly inject the steroid into the epidural space so that the medication can reach the targeted inflamed nerves.
After completing the injection, the doctor applies pressure to the injection site to prevent bleeding, before cleaning the area one more time and applying a medical dressing. You will then be taken to a bed or chair to rest, while the medical team observes you for any changes or reactions to the medication before you leave.
What Happens After a Lumbar Epidural Steroid Injection (ESI) Procedure?
The steroids will take a few days to start taking effect. Not long after the injection, your legs may feel slightly heavy and numb, but this should subside slowly. While you may also not exhibit any pain or discomfort at first due to the local anaesthesia, the pain and discomfort may return as the anaesthetic’s effects wear off. These should also gradually subside as the steroid starts taking effect, but painkillers may help manage this pain and discomfort.
If you have received a sedative before the procedure, you should avoid driving, drinking alcohol, operating machinery, or signing important legal documents for the next 48 hours. Ensure someone is around the house to help with various tasks, allowing you time to rest and recuperate.
It is important to get sufficient rest during this time, but some physical activity is still necessary to maintain your muscle strength. Slowly increase your activity levels as your physical condition improves, restoring muscle strength to better support your spine. Be sure not to rush your recovery, as it may potentially increase your risk of further injury to the lumbar spine.
Be sure to attend follow-up appointments with your doctor. These sessions allow them to check your progress and ensure the steroid is helping relieve your symptoms. If necessary, follow-up lumbar ESIs may be scheduled to maintain consistent symptom relief.
Possible Risks and Complications from a Lumbar Epidural Steroid Injection (ESI)
With any medical procedure, there are potential risks, side effects, and complications. These may include:
- Low blood pressure.
- Headaches and nausea.
- Steroid flush, featuring noticeable facial or chest flushing with warmth and increasing temperature over a few days.
- Potential bleeding in the epidural space.
- Infection.
- Unexpected weight gain.
- Sleeping difficulties.
- Nerve damage.
- Allergic reactions.
In most cases, our pain physician will limit how often you can receive a lumbar ESI, as there is also a risk of musculoskeletal weakness with each ESI you receive.
Our Doctor
Dr. Hope Ang
MBBS (NUS) | MMed (Anaes) | FAMS
Dr Hope Ang is a Consultant Anaesthesiologist with extensive expertise in acute and chronic pain management, dedicated to helping patients regain function, reduce suffering, and improve quality of life through evidence-based, personalised care.
With more than 18 years of clinical experience, Dr Ang specialises in the assessment and treatment of complex chronic pain conditions, including musculoskeletal pain, neuropathic pain, cancer-related pain, and persistent postoperative pain. His approach integrates interventional pain procedures, ultrasound-guided regional techniques, multimodal pharmacological strategies, and close collaboration with multidisciplinary care teams to address both the physical and functional impact of chronic pain.
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
Frequently Asked Questions About Lumbar Epidural Steroid Injection (ESI)
How long do lumbar ESIs last for back pain?
The duration of a lumbar ESI may vary depending on factors such as age, overall health, and underlying conditions. Regular follow-up checks will determine how long the effects of a lumbar ESI last and may indicate the need for additional injections to maintain symptom relief.
Can lumbar ESIs permanently treat back pain?
No, lumbar ESIs are meant to deliver short-term symptom relief, allowing you to begin or continue physical therapy or avoid more intensive pain-relief procedures, such as surgery. Chronic cases of back pain may require other conservative treatments or surgical intervention to treat the root cause of back pain.
How soon can I return to normal activity levels after a lumbar ESI?
It may take a few days before you can resume normal activities, but it is essential to minimise strain on your lower back to ensure the steroid’s effects can take hold. For example, you should ask for help lifting heavy objects to avoid stressing your lower back and exacerbating your condition. Speak to your doctor for further clarification and support.
Related Treatments
A slipped disc, also known as a herniated disc, happens when the soft inner core of a disc, called the nucleus pulposus, pushes through the tough outer layer, called the annulus fibrosus.
Treatments for lower back pain include physical therapy, lumbar epidural steroid injections, spinal fusion, disk replacement and more!
