An epidural steroid injection in the lumbar spine can be accomplished three different ways. There are three different ways to get the medicine to the epidural space, I should say. One of the older ways is to do what is called a 1) Caudal Epidural Steroid Injection. So, here's the lower back. You can do a caudal where you come in from the very bottom of the spine and you push the medicine up. You can get to the epidural space by doing an 2) Interlaminar Epidural Steroid Injection. An interlaminar injection is where you basically come from the back of the spine - you pop through a ligamentum flavum and you put the medicine from the dorsal aspect - or from the back of the spine and allow it to flow forward. And then you can do what's called a 3) Transforaminal Epidural Steroid Injection. The transforaminal epidural steroid injection for a lot of cases is going to be the preferred method of getting the medicine in, but it does depend on the pathology that you are trying to treat and the underlying anatomy. A transforaminal epidural steroid injection is, basically, coming next to the foramen. So, you are coming from the side of the spine, and you're putting the medicine next to the nerves as it exits through the foramen. And those are the three ways to enter the lumbar epidural space.
Chronic low back with or without lower extremity pain is extremely common, expensive, and disabling. However, all modalities of treatments are directed towards disc herniation which is responsible for a very small proportion of the patients. Thus, chronic low back pain without disc herniation is common. Multiple modalities of treatments are utilized in managing axial or discogenic pain including surgery and epidural injections including surgery, intradiscal therapies, and epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of all modalities treatments in managing axial or discogenic pain in the lumbar spine.