Free procedure orientation

What is a LESI?

LESI stands for lumbar epidural steroid injection. It is an image-guided procedure in which a credentialed clinician places ordered medication into the epidural space of the lower spine. It may be considered when lower-spine nerve irritation is associated with pain or related symptoms; the responsible clinician determines whether it is appropriate.

Medication status: The FDA has not approved injectable corticosteroids for epidural administration. Material risks and patient-specific counseling belong to the responsible clinician and facility consent process. Review the free safety orientation.

Free procedure briefing

LESI orientation snapshot

General clinical-team orientation. Current orders, qualified-clinician direction, facility policy, and approved product information remain controlling.

CommonUsually expected

May varyPatient, approach, or care setting

Confirm locallyDoctor, nurse, technologist, and facility

1

Understand the procedure

Start with the purpose and the basic process.

ApproachMay vary

Interlaminar, transforaminal, or caudal

The procedure name alone does not establish the approach, target level, or side. Those details come from the current order and responsible clinician.

Who it may be forMay vary

People with certain nerve-related symptoms

It may be considered for pain that travels from the lower back into the leg or for symptoms linked to nerve irritation. The treating clinician decides whether it is appropriate.

How it is doneCommon

Imaging guides needle placement

The patient is positioned, the skin is cleaned and numbed, and live imaging guides the epidural needle. Contrast commonly helps confirm location before ordered medication is delivered.

2

Picture the room

See the usual setting, position, and equipment.

Where it is doneMay vary

An equipped procedure setting

This may be a hospital outpatient department, pain clinic, ambulatory procedure center, or physician office equipped for image-guided procedures.

PositioningMay vary

Face-down is common; side-lying is possible

Supports may be used for comfort and access. Patient needs and the planned approach determine the actual position.

EquipmentCommon

Imaging system, procedure table, and monitor

A fluoroscopy C-arm or CT system, compatible table, image monitor, positioning supports, and sterile setup are commonly present. Monitoring equipment depends on the case.

3

Confirm the case

These details can change and should come from current approved sources.

StaffingMay vary

Qualified clinician with clinical support

An appropriately qualified clinician performs the injection. Nursing, radiologic technologist, monitoring, recovery, and sedation support depend on the setting and plan.

Instruments and suppliesConfirm locally

Needle, syringes, sterile supplies, and contrast items

Exact needle, syringe, skin preparation, drape, and contrast-delivery selections depend on the approach and the facility’s approved source.

MedicationsConfirm locally

Verify every medication and dose

Confirm each medication, formulation, concentration, dose, route, allergy, expiration, and sequence from current orders and approved sources. Corticosteroids are not FDA-approved for epidural administration.

Approach names and terms you may hear

InterlaminarAn approach between adjacent parts of the vertebrae.

TransforaminalAn approach near the opening where a selected spinal nerve exits.

CaudalAn approach entering near the tailbone and moving toward the epidural space from below.

The name does not confirmApproach, level, side, medication, sedation, positioning, staffing, or facility workflow.

Visual orientation

Anatomy and room orientation

A conceptual view of common room elements—not a fixed staffing model, workflow, or depiction of technique.

Original medical illustration of the lumbar spine and sacrum with a circle identifying the general lower-lumbar region — **Lumbar anatomy orientation** The circle identifies the general lumbar region only; it does not indicate an exact level or injection site.

AI-generated conceptual LESI room showing a fully draped patient face-down on a procedure table, an X-ray technologist positioning a side-mounted C-arm, a clinician and surgical technologist beside the lumbar area, and a nurse near the patient's head and monitor — **Conceptual room orientation** Actual equipment, positioning, staffing, and room layout vary.

Original AI-generated VSEEE educational illustrations. They provide general anatomy and room orientation and do not establish an exact procedural site, required setup, or technique.

Room, imaging, positioning, and team context

WhereOften a hospital outpatient department, pain clinic, ambulatory procedure center, or physician office equipped for image-guided procedures.

ImagingA mobile or fixed fluoroscopy system can provide live X-ray images of the lumbar spine.

PositionFace-down positioning is common, with supports used for comfort and access. Patient needs may change this.

Who may be presentA procedural clinician and clinical support staff are common. Imaging, monitoring, and sedation support depend on the setting.

Typical sequence

Before, during, and after

Descriptive orientation—not a protocol, checklist, or set of clinical instructions.

BeforePrepare

Verify the ordered procedure

Confirm the lumbar region, indication, intended approach, level and side when specified, current imaging, consent pathway, allergies, medication plan, bleeding review, infection screening, and post-procedure arrangements.

DuringMay vary

Positioning, sterile preparation, and image guidance

After positioning and sterile preparation, local anesthetic is commonly administered. The qualified clinician advances the needle using the selected imaging method, confirms placement according to the ordered approach and local process, and administers the ordered medication.

AfterConfirm locally

Observation and discharge

Monitoring, neurologic assessment, activity guidance, glucose considerations, transportation, discharge criteria, and instructions for reporting new or worsening symptoms follow the responsible clinician’s and facility’s requirements.

What may change from case to case

ApproachInterlaminar, transforaminal, or caudal terminology may be used; do not infer the approach from “LESI” alone.

TargetLevel, side, and target depend on the order, symptoms, imaging, anatomy, and responsible clinician.

ImagingFluoroscopy or CT, projections, contrast use, and radiation workflow depend on the procedure and facility.

Medication planLocal anesthetic, corticosteroid selection, formulation, dose, and sequence require case-specific verification.

Patient supportPositioning aids, IV access, sedation, physiologic monitoring, recovery duration, and escort requirements may vary.

Facility workflowRoom assignment, team roles, time-out, medication handling, documentation, and emergency readiness follow local policy.

Safety orientation

Confirm before the procedure

These prompts do not replace the facility checklist, consent, product information, or responsible-clinician direction.

Correct order and targetConfirm the ordered lumbar procedure, indication, approach, level, side when applicable, and whether diagnostic imaging or another intervention changes the plan.

Medication and bleeding reviewFollow the current local process for anticoagulants, antiplatelet drugs, other medications, laboratory testing, and procedural timing. Do not independently stop or change a patient’s medication.

Patient factorsConfirm allergies and prior reactions, infection concerns, pregnancy status when applicable, diabetes or glucose considerations, relevant illness, neurologic baseline, positioning tolerance, and the sedation or transportation plan.

Medication verificationVerify each selected product, formulation, concentration, dose, route, expiration, labeling, handling requirement, and compatibility. Epidural corticosteroid administration is not FDA-approved.

Known risksPotential complications include temporary pain increase, headache or unintended dural puncture, bleeding or hematoma, infection, allergic reaction, medication effects, nerve injury, and rare serious neurologic events. Patient-specific counseling belongs to the responsible clinician.

Escalation and aftercareKnow the local emergency response, observation and discharge criteria, expected post-procedure effects, and pathway for escalating new weakness, numbness, severe headache, vision change, seizure, or other concerning symptoms.

Next step · VSEEE Complete

Continue from orientation to readiness

The free briefing explains the procedure. Complete continues with the LESI room, equipment, instruments, supplies, medication-source entries, staff roles, and universal readiness areas in one printable guide.

Prepared LESI setup and supply groups
Qualified support and local confirmation points
Expandable readiness review and print view

Explore Complete access Subscriber login Complete readiness access and subscription checkout are not active yet.

Source notes

Authoritative references

Use the current source and approved local documents for decisions; this page is a concise orientation.

ACR image-guided epidural steroid injection practice parameter

ACR–ASNR–ASSR–SIR–SNIS Practice Parameter for the Performance of Image-Guided Epidural Steroid Injection, revised 2025.

Open the ACR document

RadiologyInfo epidural injection overview

Patient-facing overview developed by the American College of Radiology and Radiological Society of North America.

Open Epidural Injections

FDA epidural corticosteroid safety communication

The FDA warns of rare but serious neurologic events and states that corticosteroids are not approved for epidural administration.

Open the FDA safety communication

CDC safe injection and single-dose guidance

CDC guidance addresses single-dose containers, one-patient use, aseptic technique, and injection safety for spinal procedures.

Open CDC injection-safety guidance

DEA controlled-substance registration and ordering

DEA guidance describes registration and ordering requirements for entities authorized to handle controlled substances.

Open the DEA resource guide

Lumbar Epidural Steroid Injection (LESI)