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Epidural Steroid Injections: Are They Still Useful?

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The Disc and Degenerative Disc Disease

Part of the book series: New Procedures in Spinal Interventional Neuroradiology ((NPSIN))

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Abstract

Epidural injection with corticosteroids is a common treatment option for patients with lower back pain and sciatica. Over the past several decades, the technique and indications for epidural injections have changed substantially. A variety of anesthetics as well as a number of glucocorticoids have been used. The caudal approach, which was originally described, has largely been replaced by interlaminar and transforaminal injections that are typically performed with fluoroscopic guidance.

Numerous clinical trials evaluated the effectiveness of epidural corticosteroid injections. Even though epidural injections are one of the most commonly performed procedures in managing low back and radicular pain, conflicting recommendations have been provided, despite the extensive literature. Overall, Epidural steroid injections (ESIs) are well tolerated and represent a much less invasive option than surgery. ESIs have been performed for many decades and are generally considered a very safe and moderately effective treatment for back and leg pain. When performed by an experienced physician using fluoroscopic guidance, the risk of experiencing a serious complication is rare.

The current data suggests that ESIs are best used for radicular symptoms with the goal of pain management in the acute to subacute setting to help patients be more comfortable as they progress through the generally favorable natural history of spontaneous improvement. The transforaminal route, which has been studied most recently, appears to be the most efficacious approach for monoradicular symptoms secondary to a disc protrusion. Further, placebo-controlled studies are necessary to define more conclusively the role of ESI for the various causes of radicular pain and to define the best technique for each indication.

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Author information

Authors and Affiliations

  1. Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Allan L. Brook

  2. Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Shafik Boyaji, Christopher J. Gilligan & R. Jason Yong

  3. Radiology, Massachusetts General Hospital, Boston, MA, USA

    Joshua A. Hirsch

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  1. Allan L. Brook
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  2. Shafik Boyaji
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  3. Christopher J. Gilligan
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  4. Joshua A. Hirsch
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  5. R. Jason Yong
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Corresponding author

Correspondence to Allan L. Brook .

Editor information

Editors and Affiliations

  1. Minimal Invasive Spine Therapy Department, Mediterranean Institute of Oncology, Catania, Italy

    Luigi Manfrè

  2. Department of Medical of Molecular Imaging, AZ Nikolaas, Sint-Niklaas, Belgium

    Johan Van Goethem

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Brook, A.L., Boyaji, S., Gilligan, C.J., Hirsch, J.A., Yong, R.J. (2020). Epidural Steroid Injections: Are They Still Useful?. In: Manfrè, L., Van Goethem, J. (eds) The Disc and Degenerative Disc Disease. New Procedures in Spinal Interventional Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-030-03715-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-03715-4_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03714-7

  • Online ISBN: 978-3-030-03715-4

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