title: Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review.
abstract: BACKGROUND
  Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis.
  
  
  METHODS
  Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed.
  
  
  RESULTS
  The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one.
  
  
  CONCLUSIONS
  The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However, the evidence is Level II for the long-term efficacy of caudal and interlaminar epidural injections, whereas it is Level III for short-term improvement only with transforaminal epidural injections.
authors: Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA ; Pain Management Center of Paducah, Paducah, USA.
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: Department of Anesthesia, LSU Health Science Center, New Orleans, USA.
authors: Alan David
authors: AD
authors: Kaye
authors: University of Kentucky Medical School, University of Kentucky, Lexington, USA.
authors: Kavita
authors: K
authors: Manchikanti
authors: Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA.
authors: Mark
authors: M
authors: Boswell
authors: Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA.
authors: Vidyasagar
authors: V
authors: Pampati
authors: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Joshua
authors: J
authors: Hirsch
keywords: Injections; Pain; local Anesthetic