Epidural Steroid Injection for Low Back Pain
In this article, surgeons from the University of Washington review and present the evidence for the use of epidural steroid injections (ESIs). ESI is the injection of a steroid and local anesthetic into the spine. The goal is to get temporary relief of back and leg pain (sciatica) until the condition gets better on its own.

There are risks with ESI, and they don't help everyone. Surgeons are advised to choose patients carefully for this procedure. It should be used when other nonsurgical treatment has failed. Back pain that travels down the leg must be present. ESI is not advised for patients with back pain alone. ESI may be used with spinal stenosis to manage the pain but has no curative value.

Some patients should never have an ESI. For example, anyone with uncontrolled diabetes or spine cancer should not have an ESI. The same is true for anyone on anticoagulation therapy (blood thinners).

Accurate placement of the injection is important. ESI should only be done with fluoroscopic guidance. Fluoroscopy is the use of special X-ray imaging that allows the surgeon to see the needle as it goes into the spine. The authors review specific techniques for both the injection and use of fluoroscopy.

So far studies have not answered the question of how many and how often ESIs can be given. There is no proof that a series of injections is any better than one injection for sciatica.

While some experts argue that ESI should be used early to avoid chronic pain, others say wait at least seven weeks. If the patient did not improve after the first injection, a second injection is not advised.

Surgeons are encouraged to keep up with the latest studies in this area. Patient selection is becoming increasingly important. For best results, careful patient assessment must be done with risk factors identified.
Irene A. Young, MD, et al. The Use of Lumbar Epidural/Transforaminal Steroids for Managing Spinal Disease. In Journal of the American Academy of Orthopaedic Surgeons. March 2007. Vol. 15. No. 4. Pp. 228-238.