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Essentials of Interventional Techniques in Managing Chronic Pain pp 141–186Cite as

Lumbar Epidural Injections

Abstract

Lumbar epidural injections are administered by accessing the epidural space either by caudal, interlaminar, or transforaminal approaches. Epidural injections are administered to manage chronic low back pain with or without lower extremity pain secondary to disc herniation, discogenic pain without facet joint pain, spinal stenosis, post-lumbar surgery syndrome, and degenerative disc disease.

Based on best evidence synthesis, Level II evidence is available for long-term improvement of the treatment of low back and lower extremity pain secondary to disc herniation with three approaches: central spinal stenosis with caudal and interlaminar approaches, discogenic pain without facet joint or sacroiliac joint pain with caudal and interlaminar approaches, and post-lumbar surgery syndrome with caudal approach, with three approaches for managing disc herniation. Transforaminal epidural injections are also utilized for diagnostic purposes; however, the evidence for the diagnostic accuracy is Level III to Level IV.

Keywords

  • Low back pain
  • Disc herniation
  • Discogenic pain
  • Lumbar discogenic pain
  • Lumbar spinal stenosis
  • Lumbar postsurgery syndrome
  • Lumbar radiculitis
  • Caudal epidural
  • Interlaminar epidural
  • Transforaminal epidural

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Acknowledgments

This book chapter is modified and updated from previous book chapters, “Lumbar Interlaminar Epidural Steroid Injections” by Kenneth Botwin, MD, and “Lumbar Transforaminal Epidural Injections” by Laxmaiah Manchikanti, MD; David M. Schultz, MD; and Gabor B. Racz, MD, in Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Authors and Affiliations

  1. ASIPP and SIPMS, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  3. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  4. Medical Advanced Pain Specialists Medical Pain Clinics, Shorewood, MN, USA

    David M. Schultz

  5. Interventional Spine Specialists, Cincinnati, OH, USA

    Sairam Atluri

  6. Pain Specialists of Greater Chicago, Burr Ridge, IL, USA

    Scott E. Glaser

  7. Mid Atlantic Spine and Pain Physicians, Newark, DE, USA

    Frank J. E. Falco

  8. Pain Medicine Fellowship Program, Temple University Hospital, Philadelphia, PA, USA

    Frank J. E. Falco

  9. Temple University Medical School, Philadelphia, PA, USA

    Frank J. E. Falco

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  1. Laxmaiah Manchikanti
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  2. David M. Schultz
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  3. Sairam Atluri
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  4. Scott E. Glaser
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  5. Frank J. E. Falco
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Corresponding author

Correspondence to Laxmaiah Manchikanti .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    MD Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    MD Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    MD Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    MD Joshua A. Hirsch

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Manchikanti, L., Schultz, D.M., Atluri, S., Glaser, S.E., Falco, F.J.E. (2018). Lumbar Epidural Injections. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_11

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