title: What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion.
abstract: BACKGROUND
  Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery.
  
  
  METHODS
  A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V.
  
  
  RESULTS
  Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar.
  
  
  CONCLUSIONS
  The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.
authors: Pain Management Center of Paducah, Paducah, and University of Louisville, Louisville, KY, USA.
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: Premier Pain Centers, Shrewsbury, NJ, and Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Peter S
authors: PS
authors: Staats
authors: New York University School of Medicine, New York, NY, USA.
authors: Devi E
authors: DE
authors: Nampiaparampil
authors: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Joshua A
authors: JA
authors: Hirsch
keywords: Discogenic pain; Epidural injections; Lumbar disc arthroplasty; Lumbar fusion; Randomized trials