title: The Effectiveness and Risks of Fluoroscopically Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data.
abstract: To determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections.
  
  
  
  Systematic review of the literature with comprehensive analysis of the published data.
  
  
  
  Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five 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/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence.
  
  
  
  The search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies.
  
  
  
  The body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant short-term improvement in pain.
authors.affiliation: Spine and Pain Centers, Shrewsbury, New Jersey, NJ, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sharma
authors.affiliation: Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Vorobeychik
authors.affiliation: Back and Pain Center, University of Michigan, Ann Arbor, Michigan, MI, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wasserman
authors.affiliation: Pain Management of North Idaho, Coeur D'Alene, Idaho, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jameson
authors.affiliation: Risser Orthopaedic Group, Pasadena, California, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Moradian
authors.affiliation: Spine Intervention Society, Hinsdale, Illinois, USA.
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: D001416:Back Pain / Q000628:therapy*; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D013256:Steroids
keywords: Image-Guided; Lumbar; Interlaminar; Steroid; Injection