title: The use of lumbar epidural/transforaminal steroids for managing spinal disease.
abstract: Lumbar epidural steroid injections are used to manage low back and leg pain (ie, sciatica). Utilization of the procedure is increasing, with Medicare spending for lumbar epidural procedures topping $175 million annually. Few prospective randomized controlled trials have clearly demonstrated the efficacy of epidural steroid injections; many have shown conflicting results. Several studies show favorable short-term outcomes with epidural steroid injection for radicular pain, but less conclusive results are achieved >6 months. Methodologic flaws limit interpretation of results from most scientific studies. As a tool for predicting surgical outcome, epidural spinal injection has been found to have a sensitivity between 65% and 100%, a specificity between 71% and 95%, and a positive predictive value as high as 95% for 1-year surgical outcome. Despite inconclusive evidence, when weighing the surgical alternatives and associated risk, cost, and outcomes, lumbar epidural steroid injections are a reasonable nonsurgical option in select patients.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, WA, USA.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Young
authors.forename: Garrett S
authors.initials: GS
authors.lastname: Hyman
authors.forename: Llewellyn N
authors.initials: LN
authors.lastname: Packia-Raj
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
mesh_terms: D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae; D013122:Spinal Diseases / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids