Lumbar Epidural Steroid Injection

What is Lumbar Epidural Steroid Injection?

Lumbar Epidural Steroid Injection or (ESIs) is a medical care of choice for a number of types of low back pain and leg pain.  This treatment option has been used since its inception in 1952 and remains to be an important part of the non-surgical management if not conservative alternative in addressing sciatica and low back pain.  At Portland Pain and Spine, the main objective of the procedure is to alleviate pain.  In numerous cases, the procedure alone is enough to stop the pain, but in practice, an epidural steroid injection is administered in conjunction with a bespoke rehab (including physical therapy) to produce additional comfort.

Low Back Pain

The severity of low back pain can vary from mild to debilitating. While pain may not be constant, there is potential for the condition to worsen with time. Depending on the cause, common symptoms include:

  • muscle spasms,
  • tightness of the lower back,
  • burning or stinging pain, and
  • difficulty performing certain activities

Leg Pain

Leg Pain is usually a result of overuse, wear, and tear, or injury in the joint, bone, muscle, tendon, ligaments, or soft tissues. In some cases, leg pain is a symptom of a particular lower spine problem, poor circulation, varicose veins, or blood clots. Depending on the cause, the leg pain may be:

  • burning,
  • throbbing,
  • aching or searing.
  • It may also come with tingling or shooting sensation and numbness

What does the procedure look like?

Lying face down, the patient puts a pillow under the abdominal area for additional comfort as it flexes the back.  With the patient in this position, the spine opens up which makes it easier for the physician to access the epidural space.

To desensitize the skin, a local anesthetic is applied to numb the tissue from the surface of the lamina up to the lumbar vertebrae bones.  Then the doctor inserts a bigger needle through the anesthetized track.

The doctor inserts a contrast solution via the needle through the epidural space in between the L-4 and L-5 vertebra.  The doctor utilizes a fluoroscope (a kind of x-ray equipment) to ensure that the end of the needles is accurately in place within the epidural space.  Then, a contrast solution is administered.  Injected through the track, the contrast dye needle securely positioned close to the inflamed nerve roots. The doctor utilizes the fluoroscope to validate the position of the needle tip.

Following the careful validation of the needle’s exact position, the doctor positions a steroid-anesthetic medication.  This prescription bathes the inflamed nerve roots which will help ease the pain being experienced by the patient.

After the procedure, the needle is withdrawn and the entry point in the skin is cleaned and bandaged.  Some of the patients that undergo this procedure require only one injection. For others, it will require more than one injection before the pain is alleviated.

Request An Appointment

We want to assure our patients that Portland Pain and Spine remains open and actively managing your pain. Medication management is given the highest priority. Our relocation across the hall in the Washington building is complete but requires office renovation before we can accommodate patient visits. Staffing shortages affected our ability to communicate last month, however, this was temporary. Dr. Balog has reached out to all patients but asks that if anyone has additional questions or concerns to contact him at
We have updated our phone messaging system to assist with calls. There are now options to speak with a live receptionist, leave messages or speak with our new billing company. Medical record requests can be processed on our website at and are handled by Morgan Records Management. Thank you for your patience during this transition. We look forward to providing you high-quality care as we enter into 2024! 

Wishing you all a joyful holiday season.