Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
Lumbar disc herniation pain can sometimes stubbornly persist despite rest, medication, and physical therapy. Especially when the pain radiating into the leg (sciatica) is pronounced and seriously affects daily life, my patients often ask: “Doctor, is that injection treatment suitable for me, without the need for surgery?” In this article, I want to explain in plain language the injection treatments known colloquially as the “lumbar disc herniation injection” — with the most commonly used method, the epidural injection. Let me state an important point at the outset: injection treatment is an option that sits in the middle of the treatment ladder, can be very valuable in the right patient, but is not a cure-all.
What Is Injection Treatment for Lumbar Disc Herniation?
The method meant when people say “lumbar disc herniation injection” is most often the epidural steroid injection. In this procedure, a mixture of a cortisone (steroid) and a local anesthetic drug is delivered into the space between the outer membrane of the spinal canal (the dura) and the vertebral bones — that is, the epidural space.
The logic here is as follows: when a herniation presses on a nerve root, it does not create only a mechanical compression; it also initiates an inflammatory reaction (inflammation) around the nerve, and the greater part of the pain stems from this inflammation. The injected cortisone targets the source of the pain by reducing this inflammation; the local anesthetic, meanwhile, provides quick relief in the first hours.
What Does Injection Treatment Target? A Very Important Distinction
This is the point I emphasize the most to my patients, and it is very important that it not be misunderstood: injection treatment does not eliminate, dissolve, or repair the herniation. The herniated disc tissue continues to remain in place after the procedure as well. What the injection does is reduce the inflammation caused by that herniation and, therefore, the pain.
So does this mean it is of no use? Absolutely not. Because the most valuable contribution of injection treatment is that it opens a “rehabilitation window.” When the pain decreases, the patient is relieved, becomes able to move, and during this period the right exercises and lifestyle adjustments can come into play. The body most often shrinks the herniation itself over time anyway; the injection helps to get through this healing process without pain. In other words, the injection gains value not on its own, but as part of a correct treatment program.
Who Is the Lumbar Disc Herniation Injection Applied To?
Injection treatment generally comes into consideration in the following situations:
- In persistent, stubborn pain that does not go away despite first-step methods such as rest, medication, and physical therapy.
- Especially in situations where the pain radiating into the leg (sciatica) is pronounced and seriously restricts daily life.
- As an intermediate step that can be evaluated before moving to surgery.
Epidural injections can be applied not only in lumbar disc herniation, but also in conditions such as cervical disc herniation, vertebral slippage (spondylolisthesis), and spinal canal stenosis.
Who Is the Lumbar Disc Herniation Injection Not Suitable For?
Injection treatment is not suitable for every patient. The main unsuitable situations are:
- The presence of an active infection or a skin infection at the injection site,
- Bleeding disorders or uncontrolled diabetes,
- An allergy to steroids.
Apart from these, there is one more critical point: if the herniation is putting pronounced and serious pressure on the spinal cord or the nerve, is causing progressive loss of strength, or if there are emergency symptoms such as loss of bladder and bowel control, then what must be done here is not an injection, but a surgical evaluation. In such situations, no time should be lost.
How Is the Lumbar Disc Herniation Injection Done?
First of all, I must state this: the epidural injection is not “a needle thrown at random.” For safety and accuracy, it is almost always applied under imaging guidance (fluoroscopy, that is, live X-ray, or, when necessary, under the guidance of computed tomography). In this way, the tip of the needle is placed at the exact targeted point, and the complication risk is minimized; when necessary, contrast material is given to confirm that the needle is in the correct position.
The general workflow of the process is as follows: the patient is generally laid face down, and the area is cleaned and draped in a sterile manner. The procedure is done in operating-room conditions, but without putting the patient to sleep (without general anesthesia). The epidural space is reached with a thin needle and the drug mixture is delivered. This procedure, which does not require stitches, takes only 15–30 minutes in most patients. Patients are generally discharged the same day after a short rest.
The Types of Lumbar Disc Herniation Injection
Epidural injections are divided into different types according to the route by which the needle reaches the epidural space:
- Transforaminal injection: The needle is advanced through the opening (foramen) where the nerve root exits the spine, and the drug is delivered to the point closest to the focus of inflammation. It is considered the most targeted and frequently preferred method; it is especially suitable when there is a herniation at one or two levels.
- Interlaminar (classic) epidural injection: It can be preferred in situations where the herniation is at more than one level or more than one nerve root is affected.
- Caudal injection: This is another route, applied through a natural opening in the tailbone region.
A similar method, the selective nerve root block, can be used both to reduce pain and to determine exactly which nerve root the pain stems from (a diagnostic purpose).
When Does the Injection’s Effect Begin, and How Long Does It Last?
I explain this process to my patients step by step, because managing expectations correctly is important:
- The first hours: A pronounced relief may be felt thanks to the local anesthetic.
- 24–48 hours (the transition period): While the effect of the local anesthetic decreases, the cortisone has not yet reached full capacity. At this stage, the pain partially returning or a mild soreness being felt at the injection site is an expected and normal situation; there is no need to panic.
- 2–7 days: The cortisone’s main anti-inflammatory effect becomes pronounced during this period. The full effect is generally evaluated within the first two weeks.
How long the effect will last varies greatly from person to person; in some patients it may last weeks, in others months. In suitable patients, a pain-free period lasting months can be achieved. The critical point here is this: the physical therapy and exercises begun during this pain-free period markedly increase the likelihood of the benefit being lasting.
How Many Times Is the Lumbar Disc Herniation Injection Done?
In some patients, a single injection may be enough to break the pain cycle. In some patients, repeated injections may be planned. However, there is an important limit here: the injection is not done an “unlimited” number of times. Because cortisone can have cumulative effects in the body, the intervals between injections and the total number are definitely determined by the doctor.
Is the Lumbar Disc Herniation Injection Risky? What Are Its Side Effects?
When applied under imaging guidance and in experienced hands, the epidural injection is generally a safe procedure. Even so, as with every intervention, some side effects can be seen:
- A temporary soreness at the injection site after the procedure or a short-term increase in pain (seen frequently and generally temporary).
- Rarely, infection, bleeding, or a headache due to the puncture of the membrane covering the spinal cord.
- Situations such as a temporary rise in blood sugar due to the cortisone (especially in diabetic patients) and a temporary flushing–warmth sensation in the face.
Working under imaging guidance ensures that these risks are significantly reduced.
Injection Treatment or Surgery?
These two should not be viewed as rivals of each other; they are different steps of the treatment ladder. First, I would like to remind you: only a small portion (approximately 3–5%) of patients diagnosed with lumbar disc herniation need surgery; the great majority are relieved with non-surgical methods.
Injection treatment is among these non-surgical methods and aims to control the pain. Surgery, on the other hand, comes into consideration in emergency situations such as progressive muscle weakness, severe pain that does not go away despite adequate treatment, or the disruption of bladder and bowel control. As a brain and spine surgeon, my approach, too, is always individual: by evaluating together the size of the herniation, the severity of the complaints, the neurological examination, and the patient’s general condition, the most appropriate step is decided.
In Which Symptoms Should You See a Doctor Without Delay?
Injection treatment is a pain-management method; however, some symptoms indicate that what is now needed is not an injection but an emergency evaluation. If one of the following situations is present, see a doctor or the nearest emergency department without delay:
- Inability to control urine or stool, incontinence, or loss of toilet control.
- Suddenly developing and progressive marked loss of strength in the legs.
- “Saddle”-shaped loss of sensation in the buttock, anal, and inner-thigh area.
- Unbearable pain that does not go away with anything.
Frequently Asked Questions
Below, I have gathered the most frequently asked questions about lumbar disc herniation injection treatment along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.
What is injection treatment for lumbar disc herniation?
The lumbar disc herniation injection most often refers to the epidural steroid injection. In this procedure, a mixture of cortisone and a local anesthetic is delivered into the epidural space in the spinal canal, reducing the inflammation the herniation creates around the nerve and, therefore, the pain.
Does the lumbar disc herniation injection work?
In suitable patients, it can provide significant pain relief. It can be especially effective for sciatica pain radiating into the leg. However, its effect varies from person to person, and the injection does not eliminate the herniation; it only opens a window for rehabilitation by controlling the pain.
How long does the effect of the lumbar disc herniation injection last?
The cortisone’s main effect generally begins within 2–7 days. The duration of the effect varies from person to person; in some patients it may last weeks, in others months. The exercises done during this pain-free period increase the durability of the benefit.
How many times is the lumbar disc herniation injection done?
While a single session is enough in some patients, repeated injections may be needed in others. However, it is not done an unlimited number of times; the interval between injections and the total number are determined by the doctor.
Is the lumbar disc herniation injection painful?
The procedure is done with a thin needle and generally under local anesthesia; most patients describe it as a tolerable procedure. In the first 24–48 hours after the procedure, a mild soreness at the injection site or a short-term increase in pain is an expected and normal situation.
Does the lumbar disc herniation injection dissolve or eliminate the herniation?
No. Injection treatment does not dissolve or repair the herniated tissue; the herniation continues to remain in place. The aim of the injection is to reduce the inflammation and pain caused by the herniation.
Is the lumbar disc herniation injection an alternative to surgery?
Injection treatment and surgery are different steps of the treatment ladder. By controlling the pain, the injection can, in most patients, delay surgery or make it unnecessary. However, in situations requiring surgery, such as progressive loss of strength or emergency symptoms, the injection is not an alternative.
What should I pay attention to after injection treatment?
Rest is generally recommended on the first day; the procedure does not require stitches. Remember that there may be mild pain in the first 24–48 hours. Most importantly, when the pain decreases, adhere to the physical therapy and exercise program your doctor recommends; this is the key to a lasting benefit.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The applicability, effect, and possible risks of injection treatment vary from person to person according to the type of herniation, the severity of the complaints, and the person’s general state of health, and can only be determined by a doctor who evaluates you. Before any decision regarding treatment, always consult a specialist physician. In the case of emergency symptoms such as progressive loss of strength or a change in bladder or bowel control, go to the nearest healthcare facility without delay.