Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections (LESIs) are a common treatment used to manage lower back and leg pain, often caused by conditions such as lumbar disc herniation, spinal stenosis, or degenerative disc disease. These injections deliver steroid medication that is sometimes combined with a local anesthetic into the epidural space. The steroid then coats part of the spinal cord and nerves. The goal is to reduce inflammation and swelling around irritated nerve roots, which will then decrease pain and improve mobility. Patients experiencing radicular pain (commonly known as sciatica), characterized by sharp or burning pain radiating down the leg, are among the most common candidates for this procedure.

There are two different approaches to administering lumbar epidural injections: interlaminar and transforaminal. The interlaminar approach delivers the steroid medication into the central epidural space between the laminae of two vertebrae, providing broad coverage of inflamed nerves. The transforaminal approach is more targeted because it directs the medication around and through the neural foramen (the opening where nerve roots exit the spine). This allows for precise delivery to specific nerves instead of broad coverage. The nerve is chosen based on the patient's symptoms and MRI findings. The procedure is performed under fluoroscopic (X-ray) guidance to ensure accurate needle placement.

After the injection, patients may experience immediate relief. If they do not, pain relief can be seen gradually with improvement over several days as the steroid takes effect. Some soreness at the injection site is normal. Results vary, but many patients report significant pain relief lasting weeks to months and sometimes even longer than that. This pain relief allows the patient to better engage in physical therapy or other treatments which helps keep the pain from returning.