Abstract |
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.
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Authors | Irene A Young, Garrett S Hyman, Llewellyn N Packia-Raj, Andrew J Cole |
Journal | The Journal of the American Academy of Orthopaedic Surgeons
(J Am Acad Orthop Surg)
Vol. 15
Issue 4
Pg. 228-38
(Apr 2007)
ISSN: 1067-151X [Print] United States |
PMID | 17426294
(Publication Type: Journal Article, Review)
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Chemical References |
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Topics |
- Glucocorticoids
(administration & dosage)
- Humans
- Injections, Epidural
- Low Back Pain
(drug therapy, etiology)
- Lumbar Vertebrae
- Spinal Diseases
(complications, drug therapy)
- Treatment Outcome
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