Discectomy, Epidural Steroid Injections, L4-L5 herniation



Depending on the type and severity of the underlying cause, the L4-L5 slipped disc may cause lumbar radicular pain of the L4 and/or L5 spinal nerves, also called sciatica. Common symptoms and signs include:

  • Sharp pain, typically felt as a shooting and/or burning feeling that originates in the lower back and travels down the leg in the distribution of a specific nerve, sometimes affecting the foot.
  • Numbness in different parts of the thigh, leg, foot, and/or toes.
  • Weakness while moving the thigh, knee, or foot in different directions.
  • Abnormal sensations, such as a feeling of pins-and-needles and/or tingling.


Nonsurgical Treatments for L4-L5

  • Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. For more severe pain, opioids, and/or corticosteroids may be used.
  • Physical therapy. Exercise and physical therapy can be modified to specifically target pain stemming from L4-L5 and the lower back. These therapies help stabilise the back and keep the muscles and joints well-conditioned—providing long-term relief.
  • Chiropractic manipulation. Chiropractic adjustment of the lumbar spine may help relieve pain stemming from the L4-L5.
  • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
    • Repeated bending of the spine
    • Sudden, abrupt movements, such as jumping
    • High-intensity exercise and lifting heavy weights

Injection Treatments for L4-L5

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibres to pain, generating fewer pain signals.
  • Radio-frequency ablation. Radio-frequency ablation may be used to treat pain from the L4-L5 vertebral facet joints.

Surgical Treatments for L4-L5

  • Microdiscectomy. In this surgery, a small part of the disc material near the nerve root is taken out. A portion of the bone adjacent to the nerve root may also be trimmed to relieve compression.
  • Laminectomy. A part or all of the lamina (area of bone at the back of the vertebra) is removed to provide more room for the cauda equina.
  • Foraminotomy. The opening for the spinal nerve root (intervertebral foramen) is enlarged by trimming bony overgrowth, relieving the compression.
  • Facetectomy. Nerve root compression is relieved by trimming and/or removing a part of the facet joints.
  • Lumbar artificial disc replacement. This surgery is not very common and includes a complete replacement of the intervertebral disc to relieve nerve root compression and replace it with an artificial implant.
  • Fusion of L4-L5. Depending on the extensiveness of the surgery and the amount of bone removed, the surgical segment may be fused with the adjacent motion segment to provide stability. https://www.nhs.uk/conditions/slipped-disc/
back pain


A herniated disk can press on the nerves in your spine and cause pain, weakness and sometimes numbness. Sometimes these symptoms can be severe enough to disrupt your life.

Most of the time the problems from your herniated disk should start to improve on their own within a few weeks. In the meantime, try one or more of these treatments to help you feel better.


Take it easy for a few days. Rest can relieve swelling and give your back time to heal. While your back hurts, avoid exercise and other activities where you have to bend or lift.


Take an over-the-counter pain medicine like ibuprofen or naproxen. These medicines can help relieve your pain and bring down swelling. Just don’t use these for more than 10 days without talking to your doctor.

Physical Therapy

Some exercises can help improve the symptoms of a herniated disc. A physical therapist can teach you which exercise strengthen the muscles that support your back.
Physical therapy programs also include:

  • Aerobic exercises – such as walking or riding a stationary bicycle
  • Ice and heat
  • Stretching exercises to keep your muscles flexible
  • Electrical muscle stimulation
  • Ultrasound therapy


If rest, pain relievers, and physical therapy don’t help with your pain, your doctor can inject steroid medicine into space around your spinal nerve. This is called an epidural injection. The steroid can help bring down the swelling, help you move more easily, and ease pain from a herniated disk.


Most people with a herniated disk don’t need surgery. Rest and other treatments should start to improve your symptoms within 4 to 6 weeks. But if your pain doesn’t improve, surgery might be an option.

Talk to your doctor about surgery if:

  • You’re not getting relief from pain relievers, injections, and physical therapy.
  • Your symptoms keep getting worse.
  • You have trouble standing or walking.
  • You can’t control your bowels or bladder. https://www.nhs.uk/conditions/slipped-disc/
Back pain and steroids


Most back pains calm down over a few weeks when taking over-the-counter medication, staying as active as possible and including physical therapy. This form of treatment is conservative management of back pain.

For some back pain, the conservative management may not relieve the agony of pain soon enough especially if the back pain is caused by an irritated spinal nerve.

A range of steroids exist, some are short-acting which works almost immediately but they only give short lived relief. Longer-acting steroid takes around a week to work but can last for several months. The clinician who will be performing the injection will choose the most appropriate steroid medicines and dose for your condition and symptoms.


If you have local anaesthetic, your pain will be relieved within minutes but may wear off after an hour or two. It usually takes several days for the effect of the steroid to fully begin to work.

Local anaesthetic may cause numbness and make it difficult to drive as a result you may wish to arrange alternative transport home after injection.

If you had an injection into the joint you should try to avoid strenuous exercises for two days after the injection. If you are having an injection around a tendon, you may be asked to avoid heavy impact and loading activities for two or three weeks.


  • Pain at the injection site.
  • Occasionally people may notice a flare-up of their pain within the first 24 hours after injection. This usually settles itself within a couple of days.
  • Injections can occasionally cause some thinning and changed in the colour of the skin at the injection site. In rare cases, a steroid injection into muscles or joints can cause an indentation in the skin around the area.
  • Infection. Very rarely, an infection can occur in the joint. If the joint becomes more painful and hot, you should seek medical attention immediately especially if you are also feeling generally unwell.
  • People are often concerned around the possibility of steroids related side effects such as weight gain. One of the advantages of the steroids injection, compared with steroids tablets, is that the injection dose can be kept at a low dose. This means the chances of these systemic side effects are very rare.
  • Other possible side effects include facial flushing, temporary changes in mood. https://www.nhs.uk/conditions/steroid-injections/
Epidural Steroid Injections


Some people who suffer from back pain are given epidural steroid injections to try help relieve their back pain. A person receiving these injections is only given few a year, usually 2 and in most cases not more than 3 injections a year. Do you know the reason why they are given few injection?

… its because there’s a chance that these drugs might weaken your spinal bones and nearby muscles. This is not caused by the needle, its a possible side effect of steroids.

Epidural steroid injections contain drugs that mimic the effect of the hormones cortisone and hydrocortisone. When injected near irritated nerves in your spine, these drugs may temporarily reduce inflammation and help relive pain.

Steroid injections also disrupt your body’s natural hormone balance. Delaying repeat injections allows your body to return to its normal balance. This is the reason why these injections are not give too frequently.