Epidural Steroid Injections for Back Pain Treatment offer mixed results: AAN
A review by the American Academy of Neurology (AAN) has found that epidural steroid injections (ESIs) provided short-term relief for patients with radiculopathy. However, their effectiveness in other cases was unclear or limited, with minimal impact on reducing overall back pain and disability. The recent study was conducted by Carmel A. and fellow researchers.
ESIs are commonly used for managing pain and disability associated with cervical and lumbar spinal stenosis and radiculopathies. While ESIs have been widely adopted, their long-term effectiveness remains uncertain. This systematic review evaluated evidence from 90 RCTs conducted between January 2005 and January 2021, aiming to clarify the extent of pain relief and functional improvement achieved through ESIs.
The researchers conducted a search of multiple databases for RCTs evaluating the effectiveness of ESIs in cervical and lumbar spinal stenosis and radiculopathies. Because of the large variability in outcome measures across studies, SRD was used to synthesize data standardized for analysis. NNT was also computed for clinical interpretation. The outcomes of short-term and long-term pain and disability measurements were evaluated to determine the efficacy of ESIs.
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
