title: The Effectiveness and Risks of Non-Image-Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data.
abstract: To determine the effectiveness and risks of non-image-guided lumbar interlaminar epidural steroid injections.
  
  
  
  Systematic review.
  
  
  
  Three reviewers with formal training and certification in evidence-based medicine searched the literature on non-image-guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented.
  
  
  
  The primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids, and complications were noted, if reported. The evidence was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence.
  
  
  
  The searches yielded 92 primary publications addressing non-image-guided lumbar interlaminar epidural steroid injections. The evidence supporting the effectiveness of these injections for pain relief and functional improvement in patients with lumbar radicular pain due to disc herniation or neurogenic claudication secondary to lumbar spinal stenosis is limited. This procedure may provide short-term benefit in the first 3-6 weeks. The small number of case reports on significant risks suggests these injections are relatively safe. In accordance with GRADE, the quality of evidence is very low.
  
  
  
  In patients with lumbar radicular pain secondary to disc herniation or neurogenic claudication due to spinal stenosis, non-image-guided lumbar interlaminar epidural steroid injections appear to have clinical effectiveness limited to short-term pain relief. Therefore, in a contemporary medical practice, these procedures should be restricted to the rare settings where fluoroscopy is not available.
authors.affiliation: *Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania yvorobeychik@psu.edu.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Vorobeychik
authors.affiliation: Spine and Pain Centers, New Jersey and New York.
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Smith
authors.affiliation: Indiana University Health, La Porte, Indiana.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Milan P
authors.initials: MP
authors.lastname: Stojanovic
authors.affiliation: Medical Associates of North Georgia, Canton, Georgia.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Lobel
authors.affiliation: CIRCE Medical Services, Johnson City, Tennessee.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Valley
authors.affiliation: **Spine Intervention Society, Crystal Lake, Illinois.
authors.forename: Belinda
authors.initials: B
authors.lastname: Duszynski
authors.affiliation: Department of Orthopedics, Stanford University, Redwood City, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region; D059408:Pain Management / Q000379:methods*
chemical_list: D005938:Glucocorticoids
keywords: Blind; Epidural; Injection; Interlaminar; Low Back Pain; Lumbar; Pain; Radiculopathy; Spinal Stenosis; Steroid