1. From a systematic review, epidural steroid injections improved short-term pain and function in radiculopathy, with no long-term benefits over placebo.
2. Epidural steroid injections had no short- or long-term effects on symptoms of spinal stenosis.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Low back pain is one of the most common clinical conditions, with radiculopathy and spinal stenosis being two difficult-to-treat causes of chronic back pain. Although epidural corticosteroid injection is available, prior studies examining this treatment’s effectiveness have produced conflicting results. The current study analyzed previous findings in the literature to determine the efficacy of epidural steroid injections as a treatment for radiculopathy and spinal stenosis. The results demonstrated that steroid injections are associated with only short-term improvement in pain intensity and function versus placebo for the treatment of radiculopathy, with no long-term benefits. Additionally, steroid injections showed no significant difference in pain or function scores versus placebo for the treatment of spinal stenosis. This systematic review was limited by the few number of available studies that compared epidural injections with placebo treatment for spinal stenosis, with only a few having a “good-quality” evidence rating. This study’s findings suggest that epidural corticosteroid injections may have minor, short-lived benefits in the treatment of radiculopathy, but the long-term efficacy is unclear.
In-Depth [systematic review and meta-analysis]: Fifty-nine randomized, controlled trials were chosen from a total of 202 that were identified by searching Medline, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews for studies published from 2008 through May 2015. Thirty trials compared epidural steroid injections with placebo treatment for radiculopathy, while eight trials compared said injections with placebo treatment for spinal stenosis. In the treatment of radiculopathy, epidural steroid injections were associated with greater immediate improvement in pain intensity scores compared with placebo (weighted mean difference [WMD] -7.55; 95%CI -11.4 to -3.74). Steroid injections also led to greater immediate functional improvement versus placebo (WMD -0.33; 95%CI -0.56 to -0.09). There were no significant differences in pain or functional improvement between epidural corticosteroid injections and placebo treatment for spinal stenosis (WMD 0.62 to 3.73 for pain). Treatment harms were exceedingly rare but also poorly reported by the included trials.
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