Healthcare providers use lumbar epidural steroid injections (ESIs) as a pain relief option for certain causes of chronic low back pain. They inject an anti-inflammatory medication into the epidural space around your spinal nerves. Lumbar ESIs are most effective in providing pain relief from a herniated disk and spinal stenosis.
A lumbar epidural steroid injection (lumbar ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around the spinal nerves in your low back. The main goal of lumbar epidural steroid injections is to manage chronic pain caused by irritation and inflammation of the spinal nerve roots in your low back (the lumbar region of your spine) due to certain conditions or injuries. This type of chronic pain is called lumbar radiculopathy (radicular pain), which can radiate down from your low back to your hips, legs and/or feet.
Healthcare providers may recommend lumbar epidural steroid injections for chronic pain management. Your provider injects a steroid or corticosteroid medication into the epidural space by your spinal cord in your low back.
The lower back region of your spine is called the lumbar spine. This region is made up of five vertebrae, and these vertebrae are the largest of the other vertebrae in your spine. They extend from your lower thoracic spine (chest) to your sacrum (the bottom of your spine).
Your vertebrae are the 33 individual, interlocking bones that form your spinal column, which runs from the base of your brain to your tailbone. These bones help protect your spinal cord from injury while allowing you to twist and turn. Between the vertebral bones are disks that provide cushioning for your vertebrae and flexibility for you.
The five vertebrae in your lumbar spine are named lumbar 1 (L1) through lumbar 5 (L5) from top to bottom. The lumbar vertebrae have several important roles, including:
Your spinal cord is a very important bundle of nerves that runs from your brain to your low back. Your spinal cord acts like a highway that connects the nerves located all over your body to your brain so that your brain can communicate with the rest of your body.
Sometimes, nerve roots that are attached to the lumbar region (low back region) of your spinal cord can become pinched or inflamed. This can happen, for example, if you have a herniated disk. The inflamed nerves can cause pain that may radiate down your leg(s).
During a lumbar epidural steroid injection procedure, your provider injects a steroid into the epidural space around your spinal cord. The epidural space surrounds your spinal cord like a sleeve and contains fat, spinal nerves, blood vessels and connective tissue. The steroid acts on the irritated nerve(s) that are causing your pain and reduces swelling and pressure on the nerves.
Lumbar epidural steroid injections most often lead to temporary pain relief that lasts for three months or more, but some people may experience less or no pain relief from the injection.
Healthcare providers use lumbar epidural steroid injections to manage a type of chronic pain known as lumbar radicular pain, which is caused by spinal nerve root inflammation and irritation in your low back. Lumbar radicular pain is often called sciatica. Lumbar radicular pain can cause the following symptoms, which can radiate from your low back down the back of your leg below your knee to your calf and/or foot:
Many conditions can irritate your spinal nerve roots in your low back and cause lumbar radiculopathy (sciatica), including:
Other conditions that may be treated with lumbar ESIs include:
Epidural steroid injections are among the most common type of therapy for managing radicular pain.
In the United States, back pain is the fifth most common reason people seek medical care, and approximately 9% to 25% of people describe having low back pain with leg pain traveling down below their knee (radicular pain) per year.
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:
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:
Questions that may be helpful to ask your healthcare provider before you get a lumbar epidural steroid injection include:
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:
The general steps of a lumbar epidural steroid injection procedure include:
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:
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.
Side effects of lumbar ESIs include:
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.
The advantages of lumbar epidural steroid injections include:
Lumbar epidural steroid injections are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to lumbar ESI injections include:
While it’s very rare, receiving a lumbar epidural steroid injection can lead to some long-term complications, including:
Many people experience temporary pain relief from lumbar epidural steroid injections, and some people even experience longer-term relief lasting up to 12 months. However, some people do not experience any pain relief from ESIs.
The goal of lumbar epidural steroid injection is typically to provide adequate short-term pain relief so that you can begin or continue physical therapy or to try to avoid more intensive pain relief procedures. Physical therapy may help promote long-term pain relief by strengthening the muscles that support your spine.
If a lumbar ESI works for you and results in pain relief, your healthcare provider may recommend another injection later on. However, most providers limit people to two to three ESIs per year.
Studies on lumbar ESIs have revealed that they can provide reliable pain relief for up to 6 months in many cases. However, every person is different and experiences pain differently, so your experience may vary.
Lumbar ESIs are most successful at providing temporary pain relief for radicular pain caused by a lumbar herniated disk and lumbar spinal stenosis. One study revealed that for people with radicular pain secondary to disk herniation who received a lumbar ESI, up to 70% of them felt at least 50% better at one to two months, and 40% of them felt better at 12 months.
It’s important to remember that lumbar ESIs are not intended to cure back pain; their main goal is to provide pain relief.
If you experience any of the following symptoms after you’ve returned home from your lumbar ESI, be sure to contact your healthcare provider or go to the nearest hospital as soon as possible:
A note from Cleveland Clinic
When performed by a skilled healthcare provider, lumbar epidural steroid injections are an often effective and generally safe therapy option for chronic low back pain caused by certain conditions, especially a herniated disk and spinal stenosis. It’s important to remember that a lumbar ESI will most likely not cure your low back pain. Rather, it will provide pain relief so that you can return to your normal activities, improve your quality of life and complete physical therapy. If you’re feeling anxious about receiving a lumbar ESI, don’t be afraid to ask your healthcare provider about it and the procedure. They can answer any questions you may have.
Last reviewed by a Cleveland Clinic medical professional on 11/19/2021.
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