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The administration of corticosteroids into the epidural space to relieve both acute and chronic pain of spinal origin has been utilized for over 40 years. In 1957 Lievre et al reported the first use of epidural hydrocortisone for the relief of back pain and sciatica.1 Since that time numerous investigators have argued both for and against the efficacy of this technique versus alternative treatment modalities in providing significant lasting relief for patients suffering from low back and leg pain. In 1986 Benzon’s review of the literature on lumbar epidural steroid injections concluded that low back pain of mechanical origin, especially accompanied by signs of nerve root irritation, may respond to epidural steroid injection.2 In 1988 Rosen et al, performed a retrospective analysis of the efficacy of epidural steroid injections, studying 40 patients treated for low back pain and sciatica secondary to spinal stenosis or lumbar herniated disc. They concluded that 50% of the patients with radicular symptoms may receive temporary relief with epidural steroid injection (ESI); long-term relief, however, occurs in less then 25% of patients treated.3 In most studies the principal indications for administering epidural steroid injections included symptoms of low back pain or leg pain alone or in combination with varying selection criteria (e.g., previous surgery, duration of symptoms, patient age).


Most studies to date have been open trials of varying duration. There have been several investigations, however, that have attempted to control the variables that may influence the outcome and subsequently yield more accurate results regarding the efficacy of ESI. In a prospective, randomized, double-blind study, Dilke, Burry, and Grahame4 compared patients whose cause and duration of low back pain and radiculopathy were similar, received the same steroid medication via epidural route, and had not been treated previously. They found significantly better results in the patients receiving steroid; 21 of 35 patients (60%) compared with 11 of 36 patients (31%) in the placebo group. At the 3 month follow-up, fewer patients in the steroid group had severe residual pain (1/44 vs 6/38 patients) and a greater number of patients who received placebo injections (14 vs 3 patients) were still not working.


Overall immediate success rates of ESI vary from 25% to 89%,5–7 with long-term results falling to a mean of 80% by 6 months8 and 56% by 2 years.9 Ryan and Taylor found that 77% of their patients experiencing symptoms for less than 2 weeks obtained complete relief from epidural steroid injection, whereas response rates varied from 72%, 60%, and 43% for patients experiencing pain for 4 weeks, 6 weeks, and >6 weeks, respectively.6 White et al found that epidural steroid injections were most effective in patients with nerve root irritation manifesting as radicular pain, dermatomal hypesthesia, weakness of muscle groups innervated by the affected nerve roots, decreased deep tendon reflexes, and diminished straight leg raise. They noted success rates at 6 months for 34% of their patients with acute ...

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