Do you sometimes experience severe pain and numbness that radiates from your back down your leg? Your doctor may have told you that you "need a steroid injection in your back." It's normal to feel a little scared and nervous when you hear this. So, today we'll talk about what a lumbar epidural steroid injection is, what it does, and whether you should be afraid, all in simple terms, in language that you can understand.
Simply put, what is a Lumbar Epidural Steroid Injection?
This involves injecting a medicine, such as a steroid or corticosteroid, into the epidural space around your spinal nerves, which is located in the lower part of your back.
The main purpose of this is to control chronic pain caused by compression or inflammation of the nerve roots in the spine. This pain is medically called lumbar radiculopathy . You may have heard it called sciatica . This pain can travel from the back to the buttocks, down the leg, to the ankle, and even to the foot.
How does this vaccine work inside our bodies?
To understand this, let's first learn a little about our spine.
Think of your spine as a bunch of little bones stacked on top of each other. We call these vertebrae . There are five of these vertebrae at the bottom of your spine. Between these two bones, there's a cushion, jelly-like area. We call these intervertebral discs . These discs are what allow us to bend, extend, and twist our spine.
The spinal cord, which acts like the "main cable" of our body, runs through this spine. It is through this that the nerves spread throughout the body. So, the protective space around the spinal cord is what we call the epidural space .
Now imagine, if one of those discs we talked about bulges out a little, or if the space inside the spine decreases for some other reason, a nerve that runs through there gets compressed. Like someone stepping on a water pipe. Then that nerve swells and causes pain. That's the pain that goes down the leg.
This injection involves injecting a steroid into the epidural space, right next to the swollen, compressed nerve. This medicine directly reduces the inflammation . When the swelling goes down, the pressure on the nerve also goes down. Then the pain you feel is greatly reduced.
The important thing is that this often provides temporary relief. Some people can be pain-free for three months or more. But others may experience less relief, or even no relief at all.
What conditions is this vaccine used for?
Doctors recommend this vaccine as a treatment for various causes of back pain. Let's understand these conditions simply from the table below.
| Medical condition | Simply put... |
|---|---|
| Lumbar Herniated Disk | This is what we all call a "slipped disc." The jelly between the vertebrae bulges out and presses on a nearby nerve. |
| Lumbar Degenerative Disk Disease | The cushioning in the disc wears away with age or for other reasons. This can also cause the nerves to become inflamed. |
| Lumbar Spinal Stenosis | Narrowing of the space inside the spine where the spinal cord passes. When there is not enough space, the nerves are compressed and pain occurs. The pain is especially worse when walking. |
| Lumbar Osteoarthritis | Arthritis is a condition caused by wear and tear on the joints of the spine. This can also narrow the passageways for nerves and cause them to become compressed. |
| Localized Low Back Pain | The pain is only in one place in the back, not radiating down the leg. |
How should I prepare before getting the vaccine?
It is very important to discuss some things clearly with your doctor before getting this vaccine.
- If you are pregnant or planning to become pregnant, be sure to tell your doctor, as this procedure uses a type of X-ray (fluoroscopy).
- Tell your doctor about all the medications you are taking (blood thinners, diabetes medications, blood pressure medications, vitamins, Ayurvedic medications). He or she may ask you to stop taking some medications for a few days.
- You may be asked to fast for a few hours before the injection.
- You may be asked to have an MRI or CT scan of your back. This will help you find the exact spot where you need to inject the medicine.
- If they give you a drug to make you lose consciousness, they will tell you to bring someone to take you home.
Some good questions to ask the doctor
Don't be afraid to ask questions at a time like this. Ask your doctor about these things.
- How long does this treatment last?
- If this doesn't help me, what are my next options?
- What are the risks of this?
- What will I feel when I get the vaccine?
What actually happens during the vaccination?
This procedure is usually done in a hospital or clinic. It takes between 15 and 30 minutes. It is very important that you do not move at all during this time.
These are the steps that usually occur:
1. You will be changed into a special gown and lie on your stomach on a table. There will be a pillow under your stomach. You may be given a small amount of painkiller to help you relax.
2. The injection site is thoroughly cleaned and disinfected.
3. Next, the doctor uses an X-ray-like machine called fluoroscopy to see on the screen the exact place to insert the needle.
4. Then, a small needle is used to numb the area. So you won't feel much pain when the larger needle is inserted.
5. Now that the main needle is in the right place, that is, in the epidural space, a little dye (contrast material) is injected. Then the X-ray shows that the needle is not in a blood vessel or anywhere else, but exactly where the medicine is supposed to go.
6. Finally, the doctor carefully injects the steroid medicine.
7. When the work is finished, the needle is removed, the area is pressed a little, cleaned, and a plaster is applied.
8. After that, you will be allowed to rest for a while (from a few minutes to about an hour) and sent home after checking to see if you have any allergies to the medicine.
Does this hurt? Are there any side effects?
A question that many people have is whether this will hurt. When the numbing medicine is injected, it feels like a small needle pricking. When the main needle is inserted, you may feel more like pressure , a stinging, or a burning sensation than pain. Whatever this feels like, it is temporary. However, if you experience severe, unbearable pain, you should tell your doctor right away.
As with any medical treatment, there may be minor side effects.
- Temporary increase in pain: The pain may feel a little worse for the first two or three days before the medication starts to work.
- Bruising or soreness at the injection site: There may be a slight bruise or soreness at the injection site for a few days.
- For people with diabetes: Steroids can temporarily increase blood sugar levels. Therefore, people with diabetes should be careful about this.
- For people with glaucoma: Eye pressure may temporarily increase.
Are there any serious risks to be afraid of?
These are very rare events, meaning they don't happen very often. However, it is very important to have this treatment performed by a skilled, experienced doctor to minimize these risks.
- Infection: A germ can enter the area where the needle is inserted.
- Bleeding: If the needle hits a blood vessel and damages it, blood can collect in the epidural space.
- Nerve damage: Very rarely, the needle may hit and damage a nerve.
- Severe headache: If the needle hits the thin membrane surrounding the spinal cord, some cerebrospinal fluid can leak out, causing a severe headache that is especially severe when standing up.
It is because of risks like these that doctors generally do not recommend more than two or three vaccinations per year .
What symptoms should prompt you to see a doctor immediately?
If you experience any of the symptoms below after you get vaccinated and go home, call your doctor immediately, or go to the Emergency Department (ETU) at the nearest hospital.
Don't ignore these symptoms. They could be a sign of a serious condition.
- A severe headache that comes on when you stand or sit and is relieved when you lie down.
- Fever .
- Inability or difficulty controlling urine or stool .
- Feeling of numbness or weakness in the legs .
Take-Home Message
- Lumbar Epidural Steroid Injection is a treatment that controls pain caused by spinal nerve inflammation, often providing temporary relief .
- This will not completely cure your condition, but it will reduce pain and allow you to do physical therapy and return to normal activities.
- Although this is generally a safe treatment , as with all medical treatments, there can be minor side effects and very rare serious risks.
- Follow your doctor's instructions carefully , both before and after treatment. Ask any questions you may have.
- If symptoms such as fever, severe headache, or weakness in the legs occur after treatment, seek medical advice immediately .
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