Epidural Steroid Injections and Low Back Pain

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Low back pain is an extremely common complaint and a major cause of work disability worldwide. As the spinal nerves emerge from the spinal cord, they travel laterally 1-2 cms before they exit the spine. It is at this exit (Intervertebral foramen) that these nerves are most likely compressed or "pinched" by either a herniated disc, bone spurs, narrowing of the exit secondary to calcification and decreased spacing between vertebrae (bones forming the spine).This pressure on the spinal nerves causes inflammation and pain. The pain could affect the back alone or can radiate to the legs, which is known as sciatica.
Man trying to lift a sofa while holding his low back in pain.The pain could affect the back alone or can radiate to the legs, which is known as sciatica.Conservative treatments for these conditions includes analgesics, anti-inflamatories, physical therapy and epidural steroid injections. Other therapies used are heat, acupuncture, massage and stress control.

Epidural steroids injections are most effective in the presence of nerve root compression.

Scientific studies often demonstrate inflammation of the spinal nerves following prolonged compression, which leads to irritation and swelling. This irritation occurs at the level of the root of the lumbar nerves. The injection of steroids, which are potent anti-inflamatories, is made into the epidural space, close to the affected nerve roots. These injections are given by pain management specialists who are well trained in this technique. Improvement of the symptoms appears to correlate well with the resolution of the nerve root inflammation. These injections are most effective when given in the first weeks of the onset of pain. Usually, two to three injections one to two weeks apart are required. Only a single injection is given if complete pain relief is achieved.

Physicians limit the number of epidural steroid injections to a maximum of three to avoid systemic side effects of the steroids. Side effects are minimal and consist mainly of mild tenderness in the area of injection which disappears in 1-2 days. Success is dependant on the cause of the pain and how long the pain has existed. The sooner the treatment is instituted, the better are the chances of getting well. This treatment, along with analgesics and physical therapy has brought relief to thousands of patients, avoiding , in the majority of cases, the need for surgery.

Commentary by Iain Kalfas, MD

This article provides a very brief review of the use of epidural steroid injections for the treatment of low back disorders. These injections are one of many conservative management options available for patients with low back pain and, in particular, pain that travels down the leg. While they are not indicated for all patients with these complaints, they may provide some relief to a percentage of patients who do not respond to other conservative management options.

Updated on: 03/27/18
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Medications for Back Pain and Neck Pain
Iain Kalfas, MD
Head, Section of Spinal Surgery
Dept. of Neurosurgery, Cleveland Clinic
Cleveland, OH
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