Lumbar Epidural Steroid Injection
Lumbar epidural steroid injection is performed for chronic pain in lower back as well as both or one of the two lower extremities. Chronic pain may be secondary to disc herniation, disc bulge, or spinal stenosis. Chronic pain is also called radiculopathy if associated with tingling and numbness and weakness in the extremities.
Pain is treated with medication, physical therapy, injection treatment or surgery. Lumbar epidural steroid injection is one of the choice of the treatment for lumbar radicular pain or sciatica pain.
Patient is brought in to the operating room awake, alert, and oriented and is asked lie in prone position. The procedure is done in strict aseptic environment to prevent any infection. The skin is prepped with antiseptic solution as suggested by surgical centre or joint commission. The space where epidural injection has to injected is selected by clinical examination as well as x-ray. Image intensifier is used prior to the procedure to check the space where the injection is the given. Local anesthesia used is 1%, Lidocaine total amount injected is 1 to 2 cc in subcutaneous tissue as well as skin. After the injection of local anesthesia, the epidural needle is used to inject the medication in to the epidural space. The epidural needle is passed through the skin, subcutaneous tissue as well as into spinous ligament into the epidural space using x-ray (AP and lateral view).
There are two techniques involved: 1) Using the air in the syringe 2) Using normal saline in the syringe to perform the injection. The needle placement once within the epidural space, dye is injected. After confirming a satisfactory spread of the dye in cephalic just toward the head or caudal which is toward the leg, then the medication are injected. Medications injected are corticosteroid, normal saline and occasionally local anesthetic. Corticosteroid used mostly is Depo-Medrol or Kenalog, the amount injected is 40 to 80 mg though in some centers higher dosage or lower dosage may be used. Normal saline is used for dilution of the cortisone, the total amount after the dilution may be between 4 to 8 cc depending on the level and the cause of the pain.
After the procedure patient is transferred to the recovery room and observed for any complication or weakness. Most of the patients go home within 30 minutes to 45 minutes.