Epidural Steroid Injections

Epidural steroid injections should theoretically diminish inflammation in the epidural space and lead to improvement in symptoms resulting from neural compression. Epidural injections are commonly used in the setting of spinal stenosis with neurogenic claudication, and unilateral or bilateral radiculopathy from disc prolapse. A recent study by Wang et al.62 suggests that epidural steroid therapy benefits patients with lumbar disc prolapse and radiculopathy. In this retrospective review, 69 patients were studied. At an average follow-up of 1.5 years, 77% had resolutions of symptoms significant enough to cause them to decline surgical intervention. Riew et al.63 studied the effect of selective nerve root injections on patients with radiculopathy from disc prolapse or foraminal stenosis. These authors found that 53% of patients were able to obtain sufficient pain relief to be able to forgo a surgical solution. However, Carette et al.,64 in a randomized prospective double-blind study, examined the effects of epidural steroid injection on sciatica due to lumbar disc prolapse. The authors found no functional benefit in the group who underwent epidural injections. Short-term improvements in leg pain and sensory deficit were noted in the treatment group, but these benefits did not last beyond 3 months. Many patients in the study went on to discectomy within a year.

Thus, from a surgical prospective, the diagnostic utility of epidural steroid injection is quite limited. Certainly, there are no convincing data suggesting that a response or lack of response to epidural injection correlates positively or negatively with the outcome of decompressive surgery. From a practical point of view, the use of epidural steroid therapy would appear to be reasonable in the symptomatic management of patients with compressive syndromes. Additionally, from a cost-effective point of view, it may be plausible to consider epidural therapy as a first-line intervention.

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