What is the efficacy of epidural steroid injections (ESIs) for LBP?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Although numerous articles have supported the benefit of ESIs for LBP, especially if the pain is caused by radiculopathy, other studies have disputed the efficacy of these procedures. Unfortunately, most of the earlier studies (those that failed to show a benefit from the injection) had significant limitations. Aside from using a less-than-desirable research methodology, most of these studies did not use fluoroscopy and radiographic contrast to document accurate placement of the injected substance into the epidural space. Many also failed to demonstrate that injection was performed at a presumed level of pathology, which has been shown to be critical to the success of ESIs.

Studies have reported that without fluoroscopy and radiographic contrast confirmation, incorrect injection placement (ie, placement outside the epidural space) occurs in 30% of cases, on average, even when ESI is performed by experienced injectionists. These methodologic problems most likely were the major factors that led to the mixed assessment of ESIs.


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