Epidural Steroid Injections for Back Pain Treatment offer mixed results: AAN

Key Findings

• In cervical and lumbar radiculopathies, ESIs probably reduce short-term pain (SRD -24.0%, 95% CI −34.9 to −12.6, NNT 4) and short-term disability (SRD −16.0%, 95% CI −26.6 to −5, NNT 6).

• ESIs possibly reduce long-term disability in radiculopathies (SRD −11.1%, 95% CI −25.3 to 3.6, NNT 9).

• There is insufficient evidence to confirm that ESIs reduce long-term pain in radiculopathies (SRD −10.3%, 95% CI −27.8 to 7.6).

• In lumbar spinal stenosis, ESIs possibly reduce short-term disability (SRD −26.2%, 95% CI −52.4 to 3.6, NNT 4) and long-term disability (SRD −11.8%, 95% CI −26.9 to 3.8, NNT 8).

• However, ESIs do not significantly reduce short-term pain in lumbar stenosis (SRD −3.5%, 95% CI −12.6 to 5.6).

• There is insufficient evidence to determine whether ESIs reduce long-term pain in lumbar stenosis (SRD −6.5%, 95% CI −22.5 to 9.8).

• In cervical spinal stenosis, evidence is insufficient to determine the effectiveness of ESIs for either pain or disability.

The study authors concluded that ESIs provide only limited benefits in managing pain and disability in cervical and lumbar radiculopathies, with some possible effectiveness in lumbar spinal stenosis, particularly in the short term. Given the variability in outcome measures, further high-quality research is needed to establish the true clinical effectiveness of ESIs.

Reference:

Armon, C., Narayanaswami, P., Potrebic, S., Gronseth, G., Bačkonja, M.-M., Cai, V. L., Dorman, J., Gilligan, C., Heller, S. A., Silsbee, H. M., & Smith, D. B. (2025). Epidural steroids for cervical and lumbar radicular pain and spinal stenosis systematic review summary: Report of the AAN guidelines subcommittee. Neurology, 104(5).https://doi.org/10.1212/wnl.0000000000213361