New Research on Interlaminar Epidural Steroid Injections for Back Pain and Sciatica

Recent reviews of clinical trials on the effectiveness of interlaminar epidural steroid injections for treatment of lower back pain and sciatica have concluded that the injections do not provide clinically meaningful pain relief in the short term and no pain relief in the long term.

It should be noted that interlaminar epidural injections are different than transforaminal epidural steroid injections (also called spinal nerve blocks) and that transforaminal epidural steroid injections have been shown to be effective for sciatica in clinical trials.

The effectiveness of lumbar interlaminar epidural steroid injections for treatment of lower back pain and sciatica continues to be a hotly debated topic.

Some physicians view epidural steroid injections as an important pain relief treatment option for many patients with severe lower back pain that radiates down the leg. They would argue that, while it doesn’t work for everyone, an epidural steroid injection is one of the only non-surgical options that can provide almost immediate pain relief for severe sciatica. Others view the recent reviews as evidence that interlaminar injections should not be performed.

As always, the devil is in the details, and significant details are left out of the clinical trial reviews. Most notably:

• The injection protocol in the studies cited do not include the use of fluoroscopy or x-ray to verify proper placement of the medication, despite the fact that fluoroscopic guidance is an important factor in the success of the procedure and is routinely used today.
• Most of the studies do not classify patients according to diagnosis and tend to 'lump' different types sources of pain together.

"These methodological flaws are considerable and make it difficult to impossible to draw conclusions from the studies. More clinical studies are needed to properly define the role of epidural steroid injections in low back pain and in sciatica" states Ray Baker, MD, a pain management physician in Bellevue Washington and Medical Advisor for Spine-health.com.

Until more definitive and reliable research is available, patients are advised to make sure that they:

1. Enlist the services of professionals with extensive experience in doing epidural steroid injections
2. Always use fluoroscopy to ensure accurate placement
3. Follow the generally accepted guidelines of limiting the number of injections to a maximum of three within any one-year period

• American Academy of Neurology
• Injections