Lower back pain is one of the most common physical health problems. According to the World Health Organisation, it’s the leading cause of disability in the world, with cases expected to reach 843 million by 2050 .
Lumbar epidural steroid injections (ESIs) are designed to treat lower back pain by reducing inflammation around the lower spine. In this article, you’ll learn all about lumbar epidural steroid injections, including why and when they’re used, expected results, side effects, and how much they cost.
Table of Contents
- What is a lumbar epidural steroid injection and how do they work?
- What are lumbar epidural steroid injections used for?
- The epidural steroid injection procedure
- Results of lumbar ESIs
- How much do lumbar epidural steroid injections cost?
- Are lumbar epidural steroid injections painful?
- Side effects of lumbar epidural steroid injections
- Getting a lumbar epidural steroid injection in London
- Lumbar epidural steroid injection FAQs
What is a lumbar epidural steroid injection and how do they work?
Steroids and corticosteroids are drugs that can reduce inflammation and irritation around the spine. Inflammation is often a key factor in low back pain, sciatica, arthritis, and other back and spine conditions.
The lumbar spine refers to the bones at the bottom of your back, between the thoracic spine and the sacrum. Injecting cortisone and/or other steroids into the lower spine can reduce swelling around bulging, degraded, or herniated discs, and alleviate lower back pain.
The adult spine is split into 24 individual vertebrae. Steroid injections can be given anywhere along the spine depending on where you’re experiencing pain. L4 and L5 are the two lowest vertebrae in the lumbar spine, so it’s common for lumbar epidural steroid injections to be administered here. Ultrasound devices are often used to pinpoint the best place to position your steroid injection.
What are lumbar epidural steroid injections used for?
Your lumbar spine helps you stand, sit, move, and bend with ease. It provides support for your upper body, protects the nerves descending into your legs and lower body, and helps mobilise your hips, waist, and ribs to keep your body strong and supple.
Lower back pain can interfere with your daily activities. When you stop moving, your muscles become weak and stiff, which makes the problem worse. That’s where lumbar epidural steroid injections come in.
Injecting steroids into the epidural space of your lumbar spine reduces swelling and inflammation around the disc, bone, or nerve that’s causing your pain. That means it can be used to treat lots of different back problems, including:
- Lumbar slipped disc — A condition in which the cushioning tissue (disc) between your lower vertebrae moves out of place, causing inflammation and possible nerve compression.
- Sciatica — Compression of the sciatic nerve, which runs from the lower back to the feet. It may be caused by a slipped disc, poor posture, arthritis, or other back problems.
- Arthritis — Cartilage in your spine begins to break down over time, causing friction, swelling, and pain between the vertebrae.
- Degenerative disc disease — Discs start to wear away over time, so your vertebrae have less cushioning. This leads to swelling and pain in the lower back.
- Injury — Sports, overexertion, or poor lifting technique can lead to muscle or joint injury. Lower back pain in runners is a relatively common problem.
- Non-specific localised low back pain — Ranging from a constant dull ache to intermittent sharp pains, non-specific low back pain can have several different symptoms and causes.
- Spinal stenosis — A condition in which the space in your lumbar spine becomes narrower, irritating nerves that run through the spinal column.
- Nerve compression — Sciatica is just one type of nerve compression. Other nerves can also be affected, leading to tingling, pain, and numbness in the arms and/or legs.
The epidural steroid injection procedure
Getting a lumbar epidural steroid injection in the L4-L5 space is a common, straightforward procedure. Here’s how it works.
1. Diagnosis and suitability assessment
First, you’ll need to make sure you’re eligible for lumbar steroid injections. Diagnostics and imaging tests at a private clinic like Harley Street Specialist Hospital allow for rapid suitability screening to confirm if a steroid injection is right for you.
Certain health conditions and medications might mean certain steroids aren’t suitable. This might be the case if you:
- Have already had a recent steroid injection (within the last three months).
- Have already had four steroid injections within the last year.
- Are scheduled to have a vaccination soon, or have had one recently.
- Have diabetes, high blood pressure, or epilepsy.
- Have an infection.
- Take certain medications, such as anticoagulants or blood thinners.
These don’t always stop you having a lumbar steroid injection, but you’ll need to make your doctor aware so they can offer you the best course of treatment.
2. Preparing for your lumbar ESI
At a private clinic, you may be able to have your injection on the same day as your assessment. So it’s important to be prepared for what you might be asked to do on the day or a few days in advance. Preparations include:
- Stopping eating or drinking for a short amount of time before your injection.
- Stopping or changing certain medications.
- Scans to confirm the best place to position the needle.
- Deciding whether you need a sedative for the procedure (in which case you might need someone else to drive you home afterwards).
- Deciding whether to have a transforaminal, interlaminar, or caudal injection. Your doctor will discuss the pros and cons of each type of back pain injection with you.
3. Receiving the injection
On the day of your procedure, you’ll change into a hospital gown and lie face down on a bed. A pillow may be placed under your stomach to support your back.
If you’ve chosen to have a sedative, you’ll be given this some time before the procedure so it has a chance to kick in. A doctor will then clean your lower back using antiseptic wipes to reduce the risk of infection.
When you’re ready, your doctor will use an ultrasound device to pinpoint the best place to inject the steroid. Ultrasound-guided imaging is a painless way to detect areas of swelling and inflammation and give the steroid the best chance of success.
Your doctor will usually inject a local anaesthetic first to reduce pain during and immediately after the procedure. Then the epidural needle is used to inject a contrast dye to make sure it’s in the right place. If it is, the steroid will be injected in the same area. If not, the needle may need to be repositioned.
4. Immediate aftercare
After the steroid has been administered, your doctor will clean and dress the injection site to stop bleeding and prevent infection. You’ll be asked to stay in the same position for a short while to allow the medicine to flow to the right area(s). You might then be moved to a chair or bed while the doctor monitors you for any side effects or reactions.
If there are no complications, you can go home the same day. If you’ve taken a sedative, you won’t be able to drive, so arrange an alternative way to get home beforehand.
Results of lumbar ESIs
Lumbar epidural steroid injections are an effective way to treat low back pain stemming from lots of different conditions. Research studies show that lumbar ESIs can improve sciatica pain by at least 75% after 60 days and one year . For a slipped disc, a lumbar ESI can improve pain by more than 50% after two weeks and one year .
However, most studies show that relief from epidural steroid injections isn’t permanent . How long epidural steroid injections last depends on:
- Extent, location, and type of pain.
- The type of steroid used.
- Needle positioning.
- Resting after the procedure.
Find out how long to rest after a cortisone injection for best results.
How much do lumbar epidural steroid injections cost?
You may be able to get a referral for a free lumbar ESI on the NHS if you have severe or chronic low back pain. But bear in mind that waiting lists can be long: in 2024, the NHS aims to refer all non-urgent care patients within 18 weeks (4.5 months) . However, the average waiting time for pain management services is often longer than this .
As a result, many patients turn to private pain management clinics for treatment, where they can self-pay or claim their treatment on private health insurance. At Harley Street Specialist Hospital, lumbar epidural steroid injection costs start at £2,176.
Are lumbar epidural steroid injections painful?
Like any injection, lumbar ESIs can be uncomfortable. The needle may be slightly larger than those used for other injections, so your doctor might give you a local anaesthetic to numb the area first. This can also reduce pain in the first few hours after your procedure.
It’s normal to feel some discomfort between the anaesthetic wearing off and the steroid kicking in. This usually lasts no more than a couple of days. After this time, you’ll start feeling a lot better than you did before the steroid injection.
Side effects of lumbar epidural steroid injections
Possible side effects of lumbar ESIs include:
- Temporary increase in pain after the anaesthetic wears off and before the steroid starts working.
- Sudden sharp pain within two days of the injection — this is known as a cortisone flare, and can be managed with ice and painkillers.
- Soreness and bruising around the injection site.
- Increase in blood sugar levels (if you have diabetes).
- Increase in blood pressure.
Because a steroid injection can affect blood pressure and sugar levels, it’s important to let your doctor know if you have high blood pressure, diabetes, glaucoma, or any other health condition(s).
Getting a lumbar epidural steroid injection in London
Harley Street Specialist Hospital is home to the largest pool of pain management consultants in the UK. Working with the most experienced physiotherapists, anaesthetists, and pain management specialists, we can often provide assessment, diagnosis, and treatment on the same day.
Book an appointment to discuss your lower back pain with our team and find your way to a complete and rapid recovery.
Lumbar epidural steroid injection FAQs
Have more questions about lumbar ESIs? Find the answers in these FAQs.
What are the risks of a lumbar ESI?
In rare cases, complications can arise following a lumbar epidural steroid injection. Here are some of the risks you should be aware of:
- Epidural headache — The needle causes fluid to leak out of the spinal column, causing a severe headache. This can often be alleviated by lying down, and will disappear in a couple of days.
- Infection — This is a risk with any injection or invasive medical procedure.
- Blood pressure changes — Steroids can affect your blood pressure, which may be dangerous if your blood pressure is already too high or low.
- Nerve or blood vessel damage — This can happen if the needle is misplaced or inserted incorrectly.
- Permanent nerve damage or paralysis — In very rare cases, an epidural steroid injection can lead to more permanent problems.
Can I have more than one lumbar ESI?
Yes. It’s normal for a lumbar ESI to provide pain relief for up to a year. But when the steroid wears off, you might opt for another injection to extend your lower back pain relief.
You can usually have up to four steroid injections in a 12-month period.
Is a lumbar ESI right for me?
Lumbar ESIs can treat lots of different kinds of lower back pain. But it’s a semi-invasive treatment, so you may want to exhaust non-invasive interventions like exercise, physiotherapy, and massage before opting for a lumbar ESI.
If these don’t work, and your doctor agrees you’re suitable for a lumbar ESI, a steroid injection is one of the fastest ways to get short- to medium-term lower back pain relief.