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The Use of Lumbar Epidural/Transforaminal Steroids for Managing Spinal Disease

Dr. Young is Clinical Assistant Professor, Department of Rehabilitation Medicine, University of Washington, Northwest Spine & Sports Physicians, PC, Bellevue, WA. Dr. Hyman is Clinical Assistant Professor, Department of Rehabilitation Medicine, University of Washington. Dr. Packia-Raj is Clinical Assistant Professor, Northwest Spine & Sports Physicians, PC. Dr. Cole is Clinical Associate Professor, Department of Rehabilitation Medicine, University of Washington.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Young, Dr. Hyman, Dr. Packia-Raj, and Dr. Cole.

Reprint requests: Dr. Young, Northwest Spine & Sports Physicians, PC, Suite D-2581750 112th Avenue NE, Bellevue, WA 98004-3727.

Lumbar epidural steroid injections are used to manage low back and leg pain (ie, sciatica). Utilization of the procedure is increasing, with Medicare spending for lumbar epidural procedures topping $175 million annually. Few prospective randomized controlled trials have clearly demonstrated the efficacy of epidural steroid injections; many have shown conflicting results. Several studies show favorable short-term outcomes with epidural steroid injection for radicular pain, but less conclusive results are achieved >6 months. Methodologic flaws limit interpretation of results from most scientific studies. As a tool for predicting surgical outcome, epidural spinal injection has been found to have a sensitivity between 65% and 100%, a specificity between 71% and 95%, and a positive predictive value as high as 95% for 1-year surgical outcome. Despite inconclusive evidence, when weighing the surgical alternatives and associated risk, cost, and outcomes, lumbar epidural steroid injections are a reasonable nonsurgical option in select patients.