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Lumbar Epidural Injection

If you suffer from chronic low back pain, leg pain, buttock pain or sciatica that has failed improve with time and/or conservative therapy, you many be a candidate for this quick and simple treatment option.

What is a Lumbar Epidural Injection?

A lumbar epidural injection (aka lumbar epidural steroid injection or LESI) is a safe, effective, and minimally invasive treatment. LESIs have been used to treat certain types of low back pain, buttock pain, leg pain and sciatica for decades. It is a procedure very similar to the epidural a woman will receive to deal with the pain associated with childbirth. With a lumbar epidural injection your doctor will place a small amount of anti-inflammatory medication into the epidural space NEAR the spine – not on it or in it. This will relieve swelling, inflammation but most importantly – PAIN.

Lumbar Epidural Injections are an easy and simple method for treating many different types of pain. Before considering surgery, ask your doctor about this life changing procedure.

Indications

Lumbar Epidural InjectionThe most commonly treated conditions treated with LESIs are:

 Lumbar radiculopathy
  Chronic low back and/or buttock pain
 Sciatica
  Spinal stenosis

Lumbar Radiculopathy is a shooting back pain that travels into the buttock, legs(s) or even the feet and toes. People will often describe the feeling as numbness or a pins and needles sensation. This is the result of the spinal cord and or cervical nerve roots becoming compressed – typically from a lumbar disc herniation or spondylosis (arthritis of the facet joints). This causes the nerves to become irritated and pain to subsequently radiate down the shoulder or arm (along the path of the affected nerve).

Click Here to Learn More About Lumbar Radiculopathy

Lumbar Nerve Basics

In the lumbar spine there is 5 pair of spinal nerves.  Each pair of nerves provides sensation and function to specific parts of the body.  Just as the levels of the lumbar spine are abbreviated, the spinal nerve pairs are numbered in a corresponding way.  The L1 nerve roots exit the left and right sides between the first and second lumbar vertebrae (L1-L2).  L5 exits between the last lumbar vertebra and the first sacral vertebra (L5-S1).

Click Here to Learn More About the Anatomy of the Spinal Cord

More Detail

Cervical Radic - Cervical Epidural InjectionEach pair of nerve roots exit the spinal column and branches out into the body forming the peripheral (outer) nervous system. These nerves innervate the upper part of the body and enable movement (motor function) and feeling (sensory function). The illustration depicts this pattern called dermatomes. The physician can use the dermatomal pattern to help diagnose the location of spinal problem based on where the patient reports pain or weakness.

Based on symptoms, medical history, physical and neurological examination, and imaging study findings (X-ray, MRI), the physician determines which spinal nerve root(s) may be generating pain and other symptoms.

What are the Benefits?

A lumbar epidural injection is a simple and relatively painless procedure.  Each treatment takes just minutes to perform and the relief can be exceptional.  Because it is considered minimally-invasive, the risk of scar tissue is virtually nonexistent. The most important aspect of this treatment is that provides rapid pain relief and allows patients to become active again, regaining the ability to resume normal daily activities.

How Does it Work?

Lumbar epidural injections serve two purposes:

  1. Reduce inflammation – This serves to calm the symptoms and aid in healing.
  2. Provide important diagnostic information – Based on the results of the injection, your physician can better determine the cause of your pain.

Spinal Cord LayersThe procedure involves injecting a corticosteroid into the epidural space.  A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective in reducing inflammation.  Sometimes a narcotic is also injected to increase pain relief.  The epidural space is the area between the protective membrane (dura mater) covering the spinal cord and the bony spinal canal.  After the medication is injected, it flows and coats the nerve roots.

Diagnostically speaking, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.

 

How Many Treatments Will I Need?

Most patients require between two and three treatments.

When Will I Feel Better?

The positive effects of the injection can occur within two to three days.  Most patients, however, begin to see results after the second injection.

Is a Lumbar Epidural Injection Right for Me?

If you are suffering from chronic low back pain, buttock pain, leg pain or sciatica pain that has gone on longer than four weeks, i.e. severe pain that has been refractory to other treatments, contact the Ainsworth Institute of Pain Management today, schedule an appointment with one of our Board Certified Physicians, and see if you could benefit from this highly effective treatment. Early treatment can increase your chances of success and decrease the likelihood of the pain worsening.

Before the Procedure

Before the procedure, the patient is typically interviewed about the medications he or she takes and is given specific instructions. Some types of medications have to be stopped several days before the procedure. In some cases, prospective patients are also asked to stop taking pain medication and anti-inflammatory agents before the procedure in order to see how much relief is derived specifically from the injection.

Procedure - Patient Details

The environment and preparation for lumbar epidural injection is similar to outpatient surgery. The patient checks into the facility, may be asked to complete some paperwork, and then changes into a hospital gown and lies on a hospital bed. An intravenous line is administered so that the patient can receive medications to during the procedure to help him or her relax. The patient is awake during the epidural injection and may be asked questions about pain during the procedure.

The patient is positioned such that the physician has good access to the lower back. This involves lying face down with a cushion under the abdomen to keep the spine flexed and the patient comfortable.  Next, the skin area is cleaned with a sterile soap.  A local anesthetic is injected to number the injection site area.

A fluoroscope, which is a type of video X-ray, is positioned over the patient. This is a large piece of equipment called the C-arm, named for its characteristic C-shape. The fluoroscope projects images on monitors in the room to show the physician and others in the room exactly what is going on. Using fluoroscopy, the physician places the needle and injects a small amount of contrast (dye) to make sure the needle is in proper position.  Next, an anesthetic and corticosteroid are injected into the epidural space.  Sometimes, pain is temporarily increased during the injection. The physician may ask the patient for feedback during the procedure and will make the patient as comfortable as possible. When the injection is over, the injection site is covered with a small bandage.

A lumbar epidural injection treatment may involve one or several injections. The entire procedure takes around 15 minutes. When it is over, the patient is brought to a recovery area where a nurse monitors him or her. When the patient can be discharged (usually in a short period of time), the nurse provides written instructions regarding home care.
Some patients experience discomfort after the procedure for two or three days.  This is normal and does not necessarily mean the corticosteroid is not taking effect. Typically, the physician’s office will call the next day to follow up. Some physicians recommend that patients keep a daily record of pain levels and symptoms following a lumbar injection to provide the medical team with information that could guide further treatment.

Risk Factors

Any medical procedure poses a risk or possible complication.  Although extremely rare, possible risks or complications include bleeding, infection, nerve injury, and allergic reaction to medication.  Other complications include a possible increase in pain, injection site tenderness, and steroid side effects. The physician will discuss the risks and benefits of a lumbar epidural injection with the patient.

The Ainsworth Institute is Here to Help

If you are suffering from back pain or sciatica and would like to see if you may be a candidate for a lumbar epidural injection, contact the Ainsworth Institute of Pain Management today.  Schedule an appointment with one of our Board Certified Physicians to learn more and see if you are a candidate for one of these state of the art treatments.

References

[1] Shulman M: Treatment of neck pain with cervical epidural steroid injection. Reg Anesth. 1986; 11:92-94.

[2] Purkis IE: Cervical epidural steroids. Pain Clin. 1986; 1:3-7.

[3] Rowlingson JC, Kirschenbaum LP: Epidural analgesic techniques in the management of cervical pain. Anesth Analg. 1986; 65:938-942.

[4] Stav A, Ovadia L, Sternberg A, et al.: Cervical epidural steroid injection for cervicobrachialgia. Acta Anaesthesiol Scand. 1994; 37:562-566.

[5] Castagnera L, Maurette P, Pointillart V, et al.: Long term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994; 58:239.

[6] Bush K, Hillier S: Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections. a prospective study with independent clinical review Eur Spine J. 1996; 5:319.

[7] Pasqualucci A, Varrassi G, Braschi A, et al. Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion. Clin J Pain. 2007; 23:551-7.

[8] Strub WM, Brown TA, Ying J, et al.: Translaminar cervical epidural steroid injection. short-term results and factors influencing outcome J Vasc Interv Radiol. 2007; 18:1151-1155.

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