Indications for Lumbar Epidural Injections

By: Richard Staehler, MD

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Several common conditions that cause severe acute or chronic low back pain and/or leg pain (sciatica) from nerve irritation can be treated by steroid injections. These conditions include:

A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves. Read Lumbar herniated disc for more information on diagnosis and treatments.
Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back. See Lumbar degenerative disc disease.
Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain. See Spinal stenosis symptoms, diagnosis and treatment.
In This Article:
Compression fractures in a vertebra. Read Diagnosing vertebral compression fractures.
Cysts which are in the facet joint or the nerve root and can expand to squeeze spine structures. See Pain from a synovial cyst in the lumbar spine.

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Annular tear, a painful condition where a tear is present in the outer layer of the disc. See Pain generated by the lumbar disc.

For these and many other conditions that can cause low back pain and/or leg pain (sciatica), an epidural steroid injection may be an effective non-surgical treatment option.

Who should avoid epidural steroid injections

Several conditions could preclude a patient from having an injection:

Local or systemic infection
Pregnancy (if fluoroscopy, a type of x-ray, is used)
Bleeding problems - patient taking blood thinners (Coumadin, etc), or patients with a bleeding problem (hemophilia, etc)

Epidural steroid injections should also not be performed on patients whose pain could be related to a tumor. If suspected, an MRI scan should be done prior to the injection to rule out a tumor.

Injections may be done, but with caution, for patients with other potentially problematic conditions such as:

Allergies to the injected solution
Uncontrolled medical problems such as renal disease, congestive heart failure and diabetes because they may be complicated by the fluid retention that a small percentage of patients experience for a few days after the injections

Use of high dose aspirin or other anti-platelet drugs (e.g. Ticlid, Plavix), all of which can cause bleeding from the procedure. These medications should be stopped prior to having an injection.