Epidural steroid injection

Epidural steroid injection for sciatica and spinal stenosis is of unclear effect.[1] The evidence to support use in the cervical spine is not very good.[3] When medical imaging is not used to determine the proper spot for injection, ESI benefits appear to be of short term benefit when used in sciatica.[4] It is unclear if ESI is useful for chronic pain after spinal surgery.[5]

Major side effects are rare.[2] These include loss of vision, stroke, paralysis, or death when the corticosteroids are infected, as in a 2012 meningitis outbreak.[2][6] Another study found an increased odds of developing epidural lipomatosis, independent of BMI or other factors.[7]

Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated.[8] Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.[8] Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.[8] While traditional techniques without image guidance, also known as blind injections, can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison.