Lumbar Transforaminal Epidural Steroid Injections for Radiculopathy

Evidence from Guidelines and Studies

The American Society of Anesthesiologists (ASA) guidelines recommend epidural steroid injections with or without local anesthetics as part of a multimodal treatment regimen for radicular pain or radiculopathy, but do not specify an expected percentage of pain relief 1
Epidural steroid injections are supported by the ASA for providing pain relief in selected patients with radicular pain, though the guidelines do not quantify the expected degree of pain relief 1
The American College of Physicians recommends that patients should have MRI evidence of pathology, such as nerve root compression and moderate to severe disc herniation, to be considered for lumbar epidural steroid injection 2

Image guidance (fluoroscopy) is strongly recommended by the ASA for both interlaminar and transforaminal epidural injections to ensure proper needle placement and maximize effectiveness 1

Reported complications of epidural steroid injections include dural puncture, insertion-site infections, cauda equina syndrome, sensorimotor deficits, discitis, epidural granuloma, and retinal complications 1
Shared decision making regarding epidural steroid injections should include a specific discussion of potential complications associated with the procedure 1