Lumbar Epidural Steroid Injection (LESI)

WHAT IS A LUMBAR EPIDURAL STEROID INJECTION (LESI)?   

LESI is the placement of anti-inflammatory medication (similar to cortisone) close to injured discs or nerves in the low back.  The steroid is injected to try to stop the release of painful chemicals, to reduce swelling of nerves and thus promote healing. The goal is to reduce pain, numbness and tingling in the back, buttock, hips, legs and feet.

These steroids are designed to be effective for one to two weeks.  Hopefully they will provide benefit for a longer period of time.  The injection may be repeated after two weeks for up to three per year, as a rule. Often the steroid is injected along with a local anesthetic, which may provide immediate temporary relief.  The pain may return after several hours.  Usually the relief from the steroid will begin in 24 to 48 hours. Not everyone will benefit from the steroid.  Rarely the pain can get worse.

WHAT IS THE EPIDURAL SPACE? 

The brain, spinal cord and the nerves that emerge from the spinal cord are surrounded by spinal fluid. The epidural space surrounds the spinal fluid, spinal cord and nerves.  It contains nerves, fat and blood vessels.

HOW IS IT DONE?

There are different approaches to the LESI:

One is between the cervical vertebrae bones, in a relative midline approach. (Translaminar  or interlaminar epidural steroid injection)  This approach is designed to spread steroid over a large area. This may more desirable if there are several damaged discs or if symptoms are on both sides.
Another is from the side at the openings through which the nerves pass on their way to the arms and hands. ( Select nerve block / Transforaminal Epdural Steroid Injection).  This is more often used for placement of the steroid around specific nerves, and also if you have had previous back surgery.

There are side effects and potential risks associated with this procedure.