Lumbar Epidural Injections

Spinal injections are used in two ways. First, they can be performed to diagnose the source of back, leg, neck, or arm pain (diagnostic). Second, spinal injections are used as a treatment to relieve pain (therapeutic).

Most spinal injections are performed as one part of a more comprehensive treatment program. Simultaneous treatment nearly always includes an exercise program to improve or maintain spinal mobility (stretching exercises) and stability (strengthening exercises).

Epidural injections are used to treat pain that starts in the spine and radiates to an arm or leg. Arm or leg pain often occurs when a nerve is inflamed or compressed ("pinched nerve").

Epidural injections involve injecting an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. This reduces the inflammation and lessens or resolves the pain. This type of epidural injection is a therapeutic one.

For diagnostic purposes, an epidural spinal injection can be done at a very specific, isolated nerve to determine if that particular nerve is the source of pain. Sometimes only an anesthetic is injected. The immediate response to the injection is closely monitored. If the pain is completely or nearly completely relieved, then that specific nerve is the primary cause of the pain symptoms. If there is little pain relief, then another source of pain exists.

Sacroiliac joint injection in the pelvis.

Sacroiliac joint (SI joint) injections are similar to facet joint injections in many ways. The SI joints are located between the sacrum and ilium (pelvic) bones.

Problems in the SI joints have been shown to cause pain in the low back, buttock, and leg. Typically, one joint is painful and causes pain on one side of the lower body. It is less common for both SI joints to be painful at the same time.

This joint can also be injected for both diagnostic and therapeutic purposes. Anesthetizing the SI joint by injection under X-ray guidance is considered the gold standard for diagnosing SI joint pain. A diagnostic injection of the sacroiliac joint with anesthetic should markedly diminish the amount of pain in a specific location of the low back, buttock, or upper leg.

A therapeutic injection will typically include a steroid medication, with the goal of providing

Source:  American Academy of Orthopaedic Surgeons

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