AANEM News Express

This is a review of 30 placebo-controlled trials on epidural corticosteroid injections (ESIs) for radiculopathy and 8 trials for spinal stenosis. It showed ESIs for radiculopathy were associated with immediate reductions in pain and function, but benefits were small and not sustained, and there was no effect on long-term surgery risk. The limited evidence suggested no effectiveness for spinal stenosis. The limited evidence on the effects of different approaches, corticosteroids, doses, and patient or technical factors, such as use of imaging guidance, duration of symptoms, or injectate volume also indicated no clear effects. In addition, there were no clear differences in effectiveness across placebo comparators. 

Comment: This review calls into question the increasing use of ESIs for common diagnoses of radiculopathy and spinal stenosis. Although there may be immediate benefit in pain and function from ESIs in cases of radiculopathy, these effects were small and not sustained and did not change long-term outcome. The use of ESIs is not without harm, as there have been reported neurologic complications as well as recent outbreak of serious fungal infections due to contaminated methylprednisolone. The value of ESIs is debatable and needs to be re-evaluated as the risk/benefit ratio may not justify their widespread use.