Lumbar Spinal Injections

Roger Kasendorf, DO

February 3, 2023

Lumbar Spinal

Lumbar spinal injections are used to diagnose and treat pain in the lumbar spine, including the lower back (lumbar spine). They can help diagnose the source of your pain or relieve your pain.

A lumbar spinal injection is a minimally invasive procedure where a local anesthetic and anti-inflammatory (steroid) medicine are injected into the lumbar spine. The steroid medication can provide long-lasting pain relief.

Epidural steroid injection (ESI)

Epidural steroid injections (ESI) are an option for treating chronic back pain caused by certain conditions. ESI is an outpatient procedure that involves injecting a mixture of steroid and local anesthetic into the epidural space.

During an ESI, your doctor uses fluoroscopic (x-ray) guidance to place a needle in the epidural space and guide it to the nerves that cause your pain. You’ll also have a contrast dye injected to make sure the steroid medication flows into the right place.

Your doctor will use a different technique for each side of your back. The choice of approach depends on your condition and whether you have metal rods or screws from a previous surgery.

Caudal block

The caudal block is a lumbar spinal injection that is often used to treat pain from nerve irritation or inflammation in the lower spine. The injection contains a combination of anesthetic and steroid medications to help reduce inflammation and pain.

When the needle is inserted through the sacrum (the large bone at the back of your spine), it delivers the medications into the epidural space (the area around the nerve roots of the spinal cord). It is widely used to control a variety of chronic pain conditions in children and adults.

The injection is usually successful and provides relief within 30 minutes. The steroid medication helps to reduce nerve inflammation and prevents pain from returning. The injection may be repeated if the pain does not improve.

Translumbar approach

The translumbar approach is the most common method of administering a spinal injection. It involves inserting a needle between two vertebrae from the back.

It is usually performed with magnetic resonance imaging (MRI). This enables the doctor to view the spine and identify the pathology that needs treatment.

MRI also helps the doctor determine what procedure or approach will be most beneficial to the patient. For example, a radiculopathy due to a far lateral disc herniation may respond better to an epidural injection than to a transforaminal approach.

The Translumbar approach has the advantage of being less traumatic to the nerve roots. However, this technique does require greater muscle retraction.

Interlaminar approach

Injections in the lumbar spine may be performed to relieve pain associated with spinal stenosis, herniated disc, and facet joint arthropathy. This interventional approach to radicular pain is minimally invasive and effective.

The interlaminar approach is a type of lumbar spinal injection, which involves injecting medication into the epidural space by directing a needle between the laminae of two adjacent vertebrae. This method is often used for treatment of a single spinal level, although it can also be utilized in patients with multi-level spinal pathology.

A directional fluoroscopy is usually used to guide needle placement during the procedure. This enables steep craniocaudal angulation that is necessary for a number of procedures, such as lumbar ESIs and L5 and S1 nerve root blocks (NRBs).

Anecdotally reported positioning errors for interlaminar and transforaminal cervical injections can have serious iatrogenic consequences. The use of pre-curved needles can help reduce these errors. They also allow a more medial positioning in relation to the dorsal root ganglion. It easier to avoid accidentally puncturing a radicular artery.