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What Is Lumbar Epidural Steroid Injection
A lumbar epidural steroid injection (LESI) is a minimally invasive procedure in which a corticosteroid (anti-inflammatory medicine) and a local anesthetic are injected into the epidural space around the spinal nerves in your lower back. The goal is to reduce inflammation and pain caused by conditions such as herniated discs, spinal stenosis, sciatica, or degenerative disc disease.
What conditions can be treated with a lumbar epidural steroid injection?
Common conditions include:
- Herniated or bulging discs
- Sciatica (radicular pain)
- Spinal stenosis
- Degenerative disc disease
- Annular tears
- Post-laminectomy syndrome (failed back surgery syndrome)
- Spondylolisthesis (mild cases)
How effective are epidural steroid injections?
Approximately 50–80% of patients experience significant pain relief. Relief can last from one week to one year (most commonly 1–3 months). Some patients get complete relief and never need another injection; others need a series of 2–3 injections for maximum benefit.
How is the procedure performed?
- Performed in an outpatient setting (usually 15–30 minutes)
- You lie face down on an X-ray table
- The skin is cleaned and numbed with local anesthetic
- Using live X-ray (fluoroscopy) guidance, the physician inserts a thin needle into the epidural space
- Contrast dye is injected to confirm correct placement
- Steroid + anesthetic mixture is injected
- A small bandage is applied afterward
Is the injection painful?
Most patients feel pressure or a brief burning sensation when the needle is placed, but the area is numbed first. Many describe it as less painful than a cortisone shot in the shoulder or knee.
Do I need a driver?
Yes. Sedation is commonly used, and if used an adult is required to take you home. Also with sedation you are to fast for 8 hours prior to the appointment.
How long is the recovery time?
You rest for 10–30 minutes after the procedure. Most people resume normal activities the next day, but we recommend avoiding strenuous activity for 24–48 hours.
When will I feel relief?
- The local anesthetic gives immediate relief (lasting a few hours)
- Steroid effect usually begins in 1–7 days (average 3–5 days)
- Some patients notice improvement the same day, others take up to 2 weeks
How many injections can I have?
Most guidelines recommend no more than 3–4 injections in a 12-month period to minimize steroid side effects.
What are the risks and side effects?
Common (usually temporary):
- Temporary pain at injection site
- Headache (1–2%)
- Flushing, sweating, or warmth
- Temporary numbness or weakness in legs
- Sleeplessness or anxiety for 1–2 days
- Slight increase in blood sugar (important for diabetics)
Rare but serious (<1%):
- Infection
- Bleeding
- Nerve injury
- Dural puncture (spinal headache)
- Allergic reaction to medication
- Very rare: paralysis or death
Are there any contraindications?
Yes. The procedure is typically not performed if you have:
- Active infection or fever
- Bleeding disorder or taking blood thinners (some can be held)
- Uncontrolled diabetes or congestive heart failure
- Allergy to contrast dye or local anesthetics
- Pregnancy
What’s the difference between transforaminal, interlaminar, and caudal epidural injections?
- Transforaminal (selective nerve root block): targets one specific nerve root; often most effective for leg pain
- Interlaminar: medication spreads more broadly in the epidural space; good for central stenosis
- Caudal: through the sacral hiatus; used for lower lumbar or sacral conditions
