Interlaminar Lumbar Epidural Steroid Injections (IL LESI): An Introduction

This patient’s pain radiated from his lower back to his left ankle. This X Ray shows the final placement of the needle in the L4-5 interspace, just to the left of midline and the injection of a small amount of contrast material to confirm its exact placement. The patient experienced slight tingling in his left calf and ankle during injection again confirming the accurate placement of the drug.

 

 

Interlaminar Lumbar Epidural Steroid Injections are the most common procedures performed in pain clinics across the country to treat back pain. The idea is to place a needle in between two of the bones in the lower back (actually in between the lamina of one vertebra and the lamina of the next lower segment) and inject a small amount of steroid medication in order to decrease inflammation and relieve chronic pain.

The injections are done in the office with the patient lying on his or her stomach on top of a special pillow. All injections at Schlesinger Pain Centers are done under local anesthesia. The procedure usually lasts less than 10 minutes and most patients agree that it hurts less than having their blood drawn.

While done blindly (with reference only to external anatomical landmarks) in the past, the standard of care now is to use image guidance on all spinal injections. This usually means live fluoroscopy, but can include ultrasound guidance in the case of pregnant women. The question of whether or not the use of X Ray contrast material is absolutely necessary of interlaminar injections is at present unresolved. The use of such guidance techniques helps to make the injections safer, less painful and more effective.

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