There are two types of lumbar epidural steroid injections, one with contrast and one without. Lumbar epidural steroid injection (without contrast) is an injection procedure that is done to help provide pain relief to the lower back as well as alleviate radiating leg pain. This procedure involves the use of a contrast solution. The steroid medication used in this injection helps to stem the swelling and inflammation that is brought on by conditions in the spine.
Before the procedure can begin, the patient is directed to lie face down and a cushion is placed beneath the stomach not only to provide comfort during the procedure but to help flex the back. By flexing the back, the spine assumes a position that allows it to open up and provides for ease of access to the epidural space. With the assistance of a fluoroscope, the proper nerve root and lumbar vertebrae are located. Once they are, a local anesthetic is applied to the skin where the injection will be made to numb it. In addition to the skin surface, tissue stretching all the way down to the lamina will also be anesthetized.
Once the anesthetics are applied to the tissues and the skin surface, a needle will be inserted through the anesthetized area to the epidural space with the aid of a fluoroscope, to the area stretching between the L-4 and L-5 vertebra. Into this epidural space, a combination of anesthetics and steroid medication is injected, enveloping the nerve root that is creating the painful sensation with the medication.
Once the injection is complete, the needle is pulled out of the skin and a band-aid is provided to provide cover to the wound caused by the needle injection. While sometimes, the procedure may need to be performed only once or twice for the desired result, in some cases, the patient may have to undergo the procedure as many as three times in order to ensure the full effects of the medication are realized.