Epidural Steroid Injections: Are They Useful?
Injections of steroids into the lumbar epidural space are frequently used for low back and related radicular leg pains. The question is do they work?
The answer: It depends on whom you ask. The controlled studies are split. Two major problems complicate the story. The first is that many different diagnoses may cause the pain, and epidural injections may work for some of these diagnoses better than others. The second problem is that the success of the injection may depend on the technique that is used.
The traditional epidural injection technique involves the doctor feeling the patients spine in order to guide the placement of a needle between the spinal vertebrae. A newer technique involves using x-ray fluoroscopy to guide the needle directly to the neural foramen, the point where the affected spinal nerve root exits the spine. This is likely to increase the success of the procedure, but a controlled study using such injection techniques has not yet been done. However, a study in the Archives of Physical Medicine & Rehabilitation did give added support to this idea. 75% of the 69 patients treated with these more precisely placed injections demonstrated good long-term benefit.
For patients with nerve root pain involving one or two roots, I believe that fluoroscopically guided foraminal injections will prove to be superior to the approaches that do not use x-ray guidance. Epidurals in general, but especially foraminal injections, do not appear to be as effective if the pain is caused by widespread degenerative or arthritic problems in the spine.
Do epidural steroid injections work? Yes, if the problem is back and leg pain triggered lumbar disc herniations, and if fluoroscopy is used to guide the injection directly to the affected nerve roots.
Do epidural injections work for other causes of back pain? Good data is not available. In my experience, the injections can often help, but with other diagnoses the rate of success is not as great.
Until next time
Steven Richeimer, M.D.
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