2021 Mar 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
ABSTRACT
Epidural steroids injections (ESI) have been utilized for the treatment of pain due to lumbar disc injuries since the 1950s. They are frequently used in the treatment of radicular pain which is a neuropathic pain syndrome along the sensory distribution of a dermatome of one or more spinal nerves. Typically, the pain is due to nerve root irritation from mechanical compression by an intervertebral herniated disc and resultant inflammation. Additional etiologies leading to mechanical spinal nerve compression include spondylosis, spondylolisthesis, and ligamentum flavum hypertrophy resulting in neuroforaminal stenosis. In persons with lumbosacral radiculopathy, more than half of the patients report interference in their activities of daily living, and a quarter continues to have severe pain that does not respond well to oral pharmacological treatments.
Approximately 14% of patients with lumbosacral radiculopathy will eventually require surgery for severe pain that may or may not be associated with neurological deficit. However, in many cases, radicular pain secondary to intervertebral disc herniation improves with medical and rehabilitative treatment. Steroid injection into the epidural space is used to achieve inflammation reduction, pain relief, and limit the need for medications or surgery.
The 3 routes for epidural steroid delivery include the transforaminal, interlaminar, and caudal approach. Utilization of fluoroscopy or less commonly, computed-tomography (CT) guidance to ensure needle placement in the proper position using contrast flow has become the standard of care. The efficacy of epidural steroid injections in lumbosacral radiculopathy has been widely studied and based on a recent systematic review that included 8 randomized controlled trials there is a strong recommendation based on moderate quality evidence that transforaminal ESIs can be used to reduce pain at 3 months. However, a clear improvement in physical disability and reduction in surgery was not consistently seen in the literature.
Cervical ESIs similarly have been shown to provide effective short-term relief for radicular cervical pain, but long-term outcomes have not been well studied. There is limited high-quality evidence that cervical ESIs can provide benefit in radiculitis secondary to disc herniation and discogenic pain. Most of the literature focuses on interlaminar cervical ESI as opposed to transforaminal cervical ESI. Though rare, the morbidity associated with ESIs can be catastrophic.