Which factors affect the efficacy of epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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As with other medical procedures, the efficacy of the ESIs is related to many factors. Aside from the clinician's experience and training, other factors that play an important role include patient selection, symptom duration, underlying pathophysiology, ESI approach, the use of fluoroscopy and contrast enhancement, and the vocational status, as well as the socioeconomic and psychological circumstances, associated with the individual patient.

In general, patients who have had symptoms for less than 3 months have response rates of 90%. When patients have had radiculopathy symptoms for less than 6 months, response decreases to approximately 70%. Response decreases to 50% in patients who have had symptoms for over 1 year. Patients with symptoms of shorter duration have more sustained relief than those with chronic pain. Patients with chronic back pain generally have better response if they develop an acute radiculopathy. Patients with factors favoring the use of ESIs also include those who have not had previous back surgery, who are not on workers’ compensation, who are aged younger than 60 years, and who are nonsmokers.

In a cross-sectional study design at a university spine center, 76 patients with sciatica were followed for a mean of 122 days after receiving transforaminal ESIs. Of these patients, 47% experienced improvement, 28% were unchanged, and 16% worsened. The least favorable outcomes were associated with patients receiving Social Security Disability Insurance (SSDI) or workers’ compensation payments and with those whose work required heavy lifting.

Patient response to ESIs is also related to underlying pathophysiology. In general, acute radicular pain from lumbar disk herniation responds more favorably than does radicular pain from lumbar spinal stenosis. Patients with radicular pain after lumbar spine surgery frequently receive less benefit from ESIs unless the radicular pain is from a recurrent herniated nucleus pulposus. Still, ESIs are often helpful for radicular pain from stenosis.

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