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.

Epidural Steroid Injections Work

Doctor 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:

  • Supporting and stabilizing your upper body.
  • Allowing twisting and bending movements.
  • Protecting your spinal cord and cauda equina (the nerves that descend from the bottom of your spinal cord).

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.

Lumbar Epidural Steroid Injections used for

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:

  • Pain.
  • Numbness.
  • Muscle weakness.
  • Tingling.

Many conditions can irritate your spinal nerve roots in your low back and cause lumbar radiculopathy (sciatica), including:

  • Lumbar herniated disk: This condition is also commonly called a slipped, ruptured or bulging disk. Disks have soft, gel-like centers and a firmer outer layer. Over time or with an injury, the outer layer weakens and can crack. A lumbar herniated disk happens when the inner substance pushes through a crack in one of the disks between two vertebrae in your low back. The leaked material may press on, irritate and/or pinch nearby spinal nerves.
  • Lumbar degenerative disk disease: This condition happens when the cushioning in between the vertebrae in your low back begins to wear away. A degenerated disk could cause local inflammation in your spinal nerve roots.
  • Lumbar spinal stenosis: This condition is the narrowing of one or more spaces within your lumbar spine. Less space within your spine reduces the amount of space available for your spinal nerve roots. A tightened space can cause the nerves to become irritated or pinched, which can lead to low back pain, especially with repeated activity like walking.
  • Lumbar osteoarthritis (lumbar spondylosis): This condition involves changes to the bones, disks and joints in your low back caused by the normal wear-and-tear of aging. Lumbar osteoarthritis can lead to narrowing of the interior of your spinal column in your low back or in the openings where spinal nerves exit, which can cause inflammation and irritation to the nerves.

Other conditions that may be treated with lumbar ESIs include:

  • Localized low back pain (axial back pain): Axial low back pain can vary widely and have numerous causes. It can be a sharp or dull pain that you experience constantly or infrequently, and the pain can range from mild to severe.
  • Neurogenic claudication: This condition happens from compression of the spinal nerves in your lumbar spine. It can cause pain or tingling in your low back and one or both of your legs, hips and buttocks. These symptoms are especially present when you’re standing upright or walking.

Procedure Details

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.