Lumbar Epidural Steroid Injection

Who performs a lumbar epidural steroid injection? (VSports注册入口)

Lumbar epidural steroid injections are very precise, so healthcare providers performing the injection must have significant specialized training. Healthcare providers who may perform lumbar ESIs include:

• Physiatrists (Physical Medicine and Rehabilitation providers).
• Radiologists.
• Anesthesiologists.
• Neurologists.
• Surgeons.

"V体育平台登录" How do I prepare for a lumbar epidural steroid injection?

Before your lumbar ESI, it’s important to tell your healthcare provider if you’re pregnant or might be pregnant due to the likely use of fluoroscopy imaging (a type of X-ray imaging) during the procedure. You also need to tell your provider which medications you're taking, including herbs, supplements and other non-prescription drugs.

Your healthcare provider will give you specific instructions about what you need to do to prepare for your ESI injection. Be sure to follow their instructions. Your provider may:

• Limit your eating or drinking (fast) for a certain amount of time before your lumbar ESI.
• Adjust certain medications you’re taking, especially blood thinner medications.
• Request an MRI or CT scan of your back before your lumbar ESI to help determine the exact area that needs to be treated.
• Make sure you have someone with you to drive you home if you’re going to take a sedative for your lumbar ESI.

Questions that may be helpful to ask your healthcare provider before you get a lumbar epidural steroid injection include:

• How often do you perform lumbar ESIs?
• What do I need to do to prepare for my lumbar ESI?
• What are the risks of getting a lumbar ESI?
• What will my lumbar ESI feel like?
• How long will my lumbar ESI last?
• If a lumbar ESI doesn’t relieve my pain, what other options do I have?

What happens during a lumbar epidural steroid injection procedure?

You will likely have your lumbar epidural steroid injection in a hospital or an outpatient clinic. In most cases, a lumbar ESI takes 15 to 30 minutes. It’s important to be very still during this procedure.

There are different ways your healthcare provider can access the epidural space around your spinal cord in your low back, which include:

• Interlaminar ESI (IESI): With this method, the path of the needle is in between two laminae in your spine to get to the epidural space. A lamina is the flat plate of bone that’s part of each vertebra in your spine. The laminae in your spine form the outer wall of the spinal canal and protect your spinal cord. Providers commonly use interlaminar lumbar ESIs to provide temporary pain relief for disk herniation, spinal stenosis with or without radicular pain and localized (axial) low back pain.
• Transforaminal ESI (TFESI): With this method, the path of the needle is through the foramina, which are openings through which nerve roots exit your spine. Providers commonly use transforaminal lumbar ESIs to provide temporary pain relief for radicular pain caused by disk herniation or a specific injury to an individual nerve root.
• Caudal ESI: With this method, the path of the needle is through the sacral hiatus, which is towards the bottom of your sacrum and just above your tailbone, to reach the lowest spinal nerves. Your sacrum is the triangular bone in your low back that’s situated between your hip bones. Providers may use a caudal lumbar ESI to provide temporary pain relief for “failed back” syndrome. Caudal ESIs generally have fewer risks than interlaminar and transforaminal ESIs.

The general steps of a lumbar epidural steroid injection procedure include:

• You will change into a medical gown and lie on a comfortable table on your belly with a pillow under your abdomen. Your healthcare provider may give you medicine to relax, such as a sedative.
• Your provider will thoroughly clean the area of your low back where they’ll insert the epidural to minimize the risk of infection.
• Your provider will use a type of imaging guidance called fluoroscopy (X-ray, or radiology imaging) to help guide the epidural needle to exactly the right position.
• Your provider may inject local anesthesia with a small needle near the area where they’ll insert the epidural. This is so you won’t feel as much pain when they insert the epidural needle, which is larger than a standard needle.
• When the epidural needle is in place in the epidural space around your spinal cord, your provider will inject a contrast material. The contrast material ensures the needle tip is in the epidural space and not inside a blood vessel or other tissue. This helps ensure that the medication will reach the inflamed nerves they are targeting.
• Your provider will then slowly inject the medication, which is usually an anti-inflammatory medication, such as a steroid or corticosteroid. Some providers may inject a mixture of a corticosteroid, normal saline and a local anesthetic.
• When your provider is done with the injection, they’ll apply pressure to the site to prevent bleeding, clean the area again and apply a dressing to the site. You’ll move into a chair or bed to rest for a few minutes to an hour. This is so your provider can make sure you don’t have any reactions to the medication before you go home.

How painful is a lumbar epidural steroid injection?

You’ll likely experience a minor pinch when your provider injects the local anesthetic to numb the area before your lumbar epidural steroid injection.

You may not feel anything during your lumbar ESI, or you may feel the following:

• Pressure.
• Tingling.
• A burning sensation.
• Momentary pain.

If you have any discomfort during the injection, it usually goes away once the injection is finished. If you feel intense, sharp pain during or after your lumbar ESI, tell your provider immediately.

What are the side effects of lumbar epidural steroid injections?

Side effects of lumbar ESIs include:

• You may experience a temporary increase in pain before the steroid medication starts working.
• You may have tenderness and/or bruising at the site of your injection.
• If your provider uses fluoroscopy for imaging guidance, there will be minimal low-level radiation exposure due to the X-rays. Fluoroscopy X-rays may be harmful to a developing fetus. It’s essential to tell your healthcare provider if you’re pregnant or might be pregnant before you undergo the procedure.
• If you have diabetes, an epidural steroid injection will likely cause high blood sugar (hyperglycemia). This could last for hours or even days.
• If you have glaucoma, an ESI may temporarily increase your blood pressure and eye pressure.

How long does a lumbar epidural steroid injection take to work?

Your pain may become worse for two or three days after your lumbar ESI before it begins to improve. Epidural steroid injections start working within two to seven days, and the pain relief can last several days to a few months or longer.