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Cited by 479Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPain Management and Treatment

The DOI matches its Crossref record; 295 of the 297 references it cites were found in a registry or an index.

Epidural Steroids in the Management of Chronic Spinal Pain: A Systematic Review

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Abdi, Salahadin·2007·Pain Physician
DOI 10.36076/ppj.2007/10/185
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Abstract

Background: Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain. Objective: To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions. Study Design: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used. Methods: Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. Three reviewers independently assessed the trials for the quality of their methods. Subgroup analyses were performed among trials with different control groups, with different techniques of epidural injections (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term). Outcome Measures: The primary outcome measure is pain relief. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term improvement is defined as 6 weeks or less, and long-term relief is defined as 6 weeks or longer. Results: In managing lumbar radicular pain with interlaminar lumbar epidural steroid injections, the evidence is strong for short-term relief and limited for long-term relief. In managing cervical radiculopathy with cervical interlaminar epidural steroid injections, the evidence is moderate. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar radicular pain is strong for short-term and moderate for long-term relief. The evidence for cervical transforaminal epidural steroid injections in managing cervical nerve root pain is moderate. The evidence is moderate in managing lumbar radicular pain in post lumbar laminectomy syndrome. The evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief, in managing chronic pain of lumbar radiculopathy and postlumbar laminectomy syndrome. Conclusion: There is moderate evidence for interlaminar epidurals in the cervical spine and limited evidence in the lumbar spine for long-term relief. The evidence for cervical and lumbar transforaminal epidural steroid injections is moderate for long-term improvement in managing nerve root pain. The evidence for caudal epidural steroid injections is moderate for long-term relief in managing nerve root pain and chronic low back pain. Key words: Spinal pain, low back pain, cervicalgia, epidural steroids, interlaminar, caudal, transforaminal, radiculopathy, axial pain, postlaminectomy syndrome, failed back surgery syndrome.

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Research works printed but not linked: 11

  1. Kepes ER, Duncalf D. Treatment of backache with spinal injections of local anesthetics, spinal and systemic ste- roids. Pain 1985; 22:33-47.
  2. Cannon DT, April CN. Lumbosacral epi- dural steroid injections. Arch Phys Med Rehabil 2000; 83:S87-S98.
  3. McQuay HJ, Moore RA, Eccleston C, Morley S, Williams AC. Systematic re- view of outpatient services for chron- ic pain control. Health Technol Assess 1997; 1:1-135.
  4. Côté P, Cassidy JD, Carroll L. The Sas- katchewan Health and Back Pain Sur- vey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998; 23:1689-1698.
  5. Taylor RS, Taylor RJ, Fritzell P. Balloon ky- phoplasty and vertebroplasty for verte- bral compression fractures: a compar- ative systematic review of efficacy and safety. Spine 2006; 31:2747-2755.
  6. Gibson JN, Waddell G. Surgery for de- generative lumbar spondylosis: up- dated Cochrane Review. Spine 2005; 30:2312-2320.
  7. Boden S, Bohlman H. The Failed Spine. Lippincott, Williams & Wilkins, Phila- delphia, PA, 2003.
  8. Manchikanti L, Pakanati RR, Pampati V. Comparison of three routes of epidur- al steroid injections in low back pain. Pain Digest 1999; 9:277-285.
  9. Flower RJ, Blackwell GJ. Anti-inflamma- tory steroid induced biosynthesis of a phospholipase A2 inhibitor which pre- vents prostaglandin generation. Nature 1979; 278:456-459.
  10. Minamide A, Tamaki T, Hashizume H, Yoshida M, Kawakami M, Hayashi N. Ef- fects of steroids and lipopolysaccha- ride on spontaneous resorption of her- niated intervertebral discs: an experi- ence study in the rabbit. Spine 1998; 23:870-876.
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Metadata

Authors
Abdi, S.
Affiliations
University of Miami (US)
Corresponding author
Abdi, Salahadin
ORCID
Abdi, Salahadin
Venue
Pain Physician
Publisher
American Society of Interventional Pain Physicians
Published
2007-01-14
Volume
1;10
Issue
1;1
Pages
185-212
ISSN
  • 1533-3159 (ISSN-L)
  • 2150-1149
DOI
10.36076/ppj.2007/10/185
OpenAlex
W1574199527
Cited by
479
References
297
Citations by year
2026: 10 · 2025: 8 · 2024: 10 · 2023: 18 · 2022: 15 · 2021: 20 · 2020: 13 · 2019: 19 · 2018: 26 · 2017: 27 · 2016: 27 · 2015: 33 · 2014: 31 · 2013: 34 · 2012: 21
FWCI
4.68
Type
journal article
Language
en
Open access
Locations
  • Pain Physician (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
epidural steroid injection, chronic spinal pain, lumbar radicular pain, cervical radiculopathy, interlaminar epidural injection, transforaminal epidural injection, caudal epidural injection, analgesia, functional improvement, return to work, psychological state, low back pain, neck pain, injection technique comparison, long-term outcomes
MeSH terms
Adrenal Cortex Hormones, Back Pain, Cervical Vertebrae, Chronic Disease, Clinical Trials as Topic, Humans, Injections, Epidural, Lumbar Vertebrae, Treatment Outcome

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