Lumbar Nerve Root Injection for Back and Leg pain

The lower part of your spine, called the lumbar spine, has vertebrae separated by soft discs that act as cushions and provide support. The nerve roots extend out from the spinal cord through small openings called foramina. Over time, wear and tear of the spine or injuries, such as herniated discs, can make these foramina narrower or pinch the nerve roots as they leave the spinal canal. This condition is called Lumbar Radiculopathy and can cause pain that spreads through your back and legs, commonly known as sciatica.

Sciatica happens when a nerve in the lower spine is compressed. This causes pain that travels down one or both legs. Symptoms include tingling, numbness, or sharp pain that makes everyday activities difficult.

Kenalog is a Steroid commonly used in Lumbar Nerve root Injections. This steroid works around the trapped and inflamed nerve root and reduces pain and inflammation around them.

It blocks the chemicals that your body releases due to the inflammation from the ruptured disc and the trapped nerve root. After the injection, there is instant pain relief. This will allow you to move your back and leg comfortably.

This increase in movement will further reduce the stiffness around the bones, ligaments and muscles of your spine.

Marcaine 0.25% is a local anaesthetic (numbing solution) used commonly by your dentist. This is also used in Lumbar Nerve root Injections. This solution works around the trapped nerve of your spine.  This works well in combination with steroid.

It blocks the pain signals released by your irritated nerve root instantly. The steroid works to control the inflammation over the long term. Due to the pain relief, there is more movement in your back and leg.

This increase in movement will further reduce the stiffness around the bones, ligaments and muscles of your spine.

Omnipaque 300 is a contrast dye that helps locate the Spinal Nerve root as it comes out of the Spinal Canal. This gives an accurate location and confirms the position of the Nerve Root. This is commonly used in Nerve Root Spine Injections.

The dye on the Xray picture will show the position of the Nerve Root. This will allow the spine surgeon to place the needle in the exact position and give the injection. This improves the safety of the procedure.

Nerve root injection contains a mixture of numbing solution (local anaesthetic) and corticosteroid (steroid). The local anaesthetic will improve the pain immediately and the steroid in the solution will act on the inflammation around the nerve roots and control the ‘sciatica pain’ in the long term. This improvement in the pain will help you move around better and mobilise your lower back. This increase in the movement of the small joints of your spine will further reduce the stiffness around the bones, ligaments and muscles.

The lumbar nerve root injection is performed with the patient lying on their stomach. First, a small amount of local anesthetic is used to numb the area where the injection will be given. Then, using an X-ray, the doctor guides the needle to the correct spot in your lower back. Once the needle is in the right place, a contrast dye is injected to confirm that the needle is next to the nerve root that is causing the pain.

After the correct position is confirmed, the steroid shot and local anesthetic are injected around the nerve root. The whole procedure usually takes less than 30 minutes. Most of the time, patients feel relief almost immediately, thanks to the local anesthetic.

X-rays will be taken (shown in picture) to make sure that the needle placement is accurate. The dye (Omnipaque 300) is not used before the anaesthetic and steroid solution is injected. You will recover from the procedure and sedation very quickly. A spinal needle is used to inject the steroid and anaesthetic solution in and around the ‘nerve root’.

After the injection, you will be taken to a recovery room where you will be monitored for about an hour. You should arrange for someone to drive you home because you may still feel drowsy from the sedation. It is important to rest for the remainder of the day and avoid strenuous activities. You can resume light activities the following day if you feel up to it.

The steroid in the injection may take a few days to start working, so you might not feel the full effect right away. You may also be asked to continue taking any pain medications you were on before the injection until you start feeling better.

• Quick Relief for Low Back Pain: The local anesthetic provides immediate pain relief, which allows patients to move more freely right after the procedure.
• Reduced Inflammation: The steroid reduces inflammation around the nerve root, which helps control pain in the long term.
• Better Mobility: Pain relief allows patients to participate in physical therapy and resume daily activities, which is important for spine health.
• Avoid or Delay Surgery: In many cases, these injections can help patients avoid surgery or delay it while they try other treatment options.

Around 70% of patients experience significant improvement after a lumbar nerve root injection. However, results can vary from person to person, and the relief can last from a few weeks to several months.

Most experts recommend not more than 2 injections over a 12-month period. There are concerns about the adverse side effects of repeated steroid injections on the nerve root and on your metabolism. There is a very small risk of diabetes, raised blood pressure, decreased immunity, recurrent infections and weight gain.

This is rare but there is an increased risk in skin conditions like psoriasis or eczema. The rate is less than 1 in 1000 injections.

There is very little chance that you will bleed from a tiny puncture wound with a needle. But there is an increased risk of bleeding if you are taking medications to ‘thin your blood’ like warfarin, rivaroxaban or clopidogrel. You will be advised to stop these medications at least a week in advance of the procedure for safety.

In rare instances, you may be allergic to the dye that is used to check the exact needle position. This happens in the range of 1in 200 to 1 in 500 injections. People who are allergic to seafood are found to be more prone to this reaction. These include skin rash, itching and flushing of the face.

This happens when there is a small leakage of the fluid present around your spinal cord from the injection. This fluid usually leaks out and can cause headache while standing and walking for a few days. You will be advised to lie down flat for a few days until the headache settles.

This is a temporary side effect from the steroid injection and settles down very quickly.

In people with diabetes or at risk of diabetes, their blood sugar is found to rise immediately after the caudal epidural injection. This will settle after a few days without treatment.

This can be due to the stress of the procedure and is not life threatening. 1 in 100 patients do have such episodes and it settles very quickly.

Lumbar Nerve root steroid injections are simple, non-invasive, safe procedure that provides instant relief from back pain and stiffness. However the results vary between patients and last anywhere between six weeks to 6 months. It is the physiotherapy exercise program that gives the maximum benefit from this injections.

These steroid injections just provide the pain relief necessary for the physiotherapy program to improve the movement. Therefore the success of the nerve root steroid injection depends on the physiotherapy program that follows after the injection.

Lumbar nerve root injections are successful for many patients in reducing pain and improving mobility. The success of the treatment largely depends on each person’s individual condition and how well they respond to the steroid. Many patients experience pain relief for a few months, which helps them to engage in physical therapy. Physical therapy is important because it helps strengthen the muscles around the spine, which can prevent future pain.

If the injection works well, patients may be able to avoid surgery. The injection can also help people get back to their daily activities without having to take a lot of pain medication.

The actual procedure of nerve root injection is not painful as it is done under sedation and it takes just 10 minutes for the actual procedure to be done. You will wake up with no pain and will be sent home with medications to control any pain after the local anaesthetic wears off.

Avoid driving for at least 12 hours after the procedure. You may suffer from dizziness or sickness as you may not have fully recovered from the sedation.  It is common to experience mild soreness at the site of the steroid injections for 24–48 hours.

Your neck may feel stiff and sudden movements or jerks can cause severe pain. So, driving may be a risk if done early.

The effect of lumbar nerve root steroid injection lasts between 6 weeks to 6 months. There is an instant pain relief from the local anaesthetic which lasts for a few hours. The cortisone (steroid) starts to work in 24 to 48 hours and last for a good few months.

In some patients they seem to last for ever. Some need a few more injections for good relief from back and leg pain.

The length of relief varies from patient to patient. Some people may feel pain relief for only a few weeks, while others may experience relief for several months. The goal of the lumbar nerve root injection is to provide enough pain relief so you can begin a physical therapy program. Physical therapy will help you build strength and improve flexibility, which can help prevent future pain.

The success of the lumbar nerve root injection can be increased by combining it with a good physical therapy program. Physical therapy exercises are designed to strengthen the muscles around your spine and improve your flexibility and posture. A strong and flexible spine can help prevent future episodes of back pain.

It is also important to maintain a healthy weight, as being overweight can put extra pressure on your spine. Regular exercise, good posture, and avoiding activities that put stress on your back can all help keep your spine healthy.

Lumbar nerve root steroid injections are successful on most occasions. However in some instances, you may need up to 2 or three sets of these injections. If this treatment with steroid injections are unsuccessful, we will carefully examine and find reasons why.

Lumbar nerve root injections are not for everyone. You should not get this injection if you have an infection, are pregnant, or have a bleeding disorder. It is important to talk to your doctor about your medical history before getting the injection to make sure it is safe for you.

This is booked in 4 weeks after the injection. It allows you to explain the progress of you back and leg pain to Mr Rajesh and he may arrange physiotherapy to build on the gains from the injection. Repeat injections or possible the need for surgery only if necessary, can be discussed.

If you are struggling with back pain or sciatica and have not found relief with other treatments, a Lumbar Nerve Root Injection could be a good option for you. This minimally invasive procedure can provide quick relief for low back pain and help improve your mobility, allowing you to participate more effectively in physical therapy and other rehab programs.

The injection can help you get back to your daily activities with less pain and can delay or even prevent the need for surgery. As always, it is important to talk to a spine specialist who can guide you to the best treatment for your specific condition.

Ready to take control of your back pain? Book a consultation today and see if a spine injection for sciatica could bring you the relief you’ve been looking for.

For more information about spine injections, spine steroid injections, and other treatments for low back pain, visit our website and learn how you can achieve lasting pain relief.