Epidural Steroid Injections for Treatment of Lumbar Spinal Stenosis
Epidural steroid injections are used to relieve pain originating in the lower back caused by symptoms like the following:
- Neurogenic intermitted claudication
Your doctor might suggest epidural steroid injections after other more conservative nonsurgical treatments have failed to relieve the pain. They may be used in conjunction with physical therapy or a rehabilitation program.1
Watch how an epidural steroid injection is performed.
How Epidural Steroid Injections Work
An epidural steroid injection contains two types of medications:
- A corticosteroid is a strong anti-inflammatory steroid medication (cortisone is one type of corticosteroid). Steroids can also reduce your immune system response so that less inflammation and pain occur in that area for a period of time. It can take several days before people feel relief from steroid medications.
- A local anesthetic such as Lidocaine numbs pain immediately, giving the steroid time to work.
The medications are injected into the space around the spinal cord. The steroid then reduces inflammation at the nerve roots caused by lumbar spinal stenosis.
Who Can Benefit From Epidural Steroid Injections
Epidural steroid injections provide the most benefit for people who have symptoms of lumbar spinal stenosis that radiate down the leg(s), rather than in the back.
Before recommending a steroid injection, your doctor may order diagnostic tests to identify the precise location of nerve compression and confirm that lumbar spinal stenosis is the cause of your pain.
Who Should Avoid Epidural Steroid Injections
Epidural steroid injections should be avoided in people with the following:
- An allergy to the steroid medications
- Tumor(s) in the spine
- Conditions like congestive heart failure or renal disease, since fluid can be retained in the body after the injection
- Pregnancy (assuming that fluoroscopy is used)
- Bleeding problems (for example, hemophilia)
The Epidural Steroid Injection Procedure
The procedure takes place in a hospital's operating room or in a clinic's procedure room. It usually takes about 15-30 minutes.
The doctor performing the procedure may be a radiologist, anesthesiologist, neurologist, surgeon, or physiatrist.
General Procedure Steps
- You may be lying face down, lying on your side, or sitting in a chair, with the spine flexed (bent forward slightly).
- The skin around the area of the injection site is cleaned.
- The skin and tissue beneath it is numbed with anesthetic. You can also choose to be lightly sedated, but there is generally little or no discomfort.
- The doctor then views your back with a fluoroscopy.
- Once the needle is in place, a contrast dye is injected and the doctor uses fluoroscopy to confirm the proper placement.
- The medication is then injected, at which point people sometimes feel slight pressure.
After the Procedure
You are monitored for a short time (15-30 minutes) after the procedure, and may be instructed to rest for the remainder of the day. You can generally resume normal activities the following day.
For several hours after the procedure, there may be tenderness at the site of the injection. For several days, there may be some pain due to the amount of fluid injected.
What to Expect From Epidural Steroid Injections
The success rate of epidural steroid injections can depend on several things:
- The condition being treated
- How long the pain has been present
- The severity of the pain
One study that looked at people with lumbar spinal stenosis and radicular leg pain found that after one year of epidural steroid injections, most patients had at least a 50% reduction in pain.2
There is no definitive agreement about the number of injections that can be given in a 6- or 12-month period. But because epidural steroid injections can have significant side effects, most doctors recommend no more than three injections per year.
Long-Term Vs. Short-Term Effectiveness of Epidural Steroid Injections
Many studies show the short-term benefits of epidural steroid injections, but there is less evidence that they remain effective in the long-term.3,7 It appears that most of the time the pain relief is temporary. Epidural steroid injections don’t address underlying problems in the spinal anatomy. Once a steroid's anti-inflammatory effects have worn off, the pain may return.
The American Academy of Neurology’s guidelines for doctors note the following for epidural steroid injections:
- They do not generally provide pain relief for longer than three months.
- They do not alter the need for surgery.3
Several recent studies have shown better outcomes with surgery compared to nonsurgical treatment, including epidural steroid injections.4,5,6
Side Effects and Risks of Epidural Steroid Injections
People who are at higher risk for infections—like those with immune system disorders—may be at higher risk for side effects. Below are some of the side effects to be aware of when considering epidural steroid injections as treatment for spinal stenosis.
Potential Less Serious Side Effects
- Back pain or tenderness for two to four days
- Headache or dizziness
- Nausea or vomiting
- Temporary weakness or numbness, often in the bowel and bladder (if the anesthetic affects other nerves)
Potential Serious and More Rare Side Effects
- Nerve root damage from the needle, or from other side effects like infection or bleeding
- Dural puncture (also called wet tap), which causes a headache
- Arachnoiditis, which is inflammation of a membrane surrounding the nerves.
Side Effects for Long-Term Use
If a number of epidural steroid injections are used over a period of time, long-term effects of corticosteroids include the following:
- Weight gain (along with redistribution of fat)
- Sleeping disorders
- Stomach ulcers
- High blood pressure
- High blood sugar (a special risk for someone with diabetes)
- Reduced ability to fight infection
- Harrast, M. Epidural steroid injections for lumbar spinal stenosis. Curr Rev Musculoskelet 2008.
- Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. Dec 2002;81 (12):898-905.
- Armon C et al. Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2007 Mar 6; 68:723-9.
- Weinstein JN, Tosteson TD, Lurie JD, et al, for the SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. NEJM. 2008;358:794-810.
- Snyder DL, Doggett D, Turkelson C. Treatment of degenerative lumbar spinal stenosis. Am Fam Physician. 2004 Aug 1;70 (3):517-20.
- Zucherman JF, Hsu KY, Hartjen CA, et al. A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine. 2005;30:1351-1358.
- Rosen, et al., A Retrospective Analysis of the Efficacy of Epidural Steroid Injections. Clin Orthop Relat Res 1988 (228) p 270-273.