Benefits of Epidural Steroid Injections for Radiculopathy
Epidural steroid injections provide immediate-term pain relief and functional improvement for patients with radiculopathy, though benefits are modest and not sustained beyond 3 months. 1, 2
Pain Relief Benefits
Epidural steroid injections reduce pain intensity by approximately 7.5 points on a 0-100 scale in the immediate term (within 2 weeks to 1 month), representing a statistically significant but clinically modest benefit. 2
Pain relief is most pronounced in the first 2 weeks following injection, with patients experiencing reduction from baseline pain scores of approximately 7.5/10 to 6.2/10 at 15 days. 3
The transforaminal approach demonstrates superior pain relief compared to interlaminar or caudal approaches, with 63-84% of patients achieving greater than 50% pain reduction at 6 months. 3, 4
Both interlaminar and transforaminal routes provide significant pain improvements maintained through 6 months of follow-up, though the difference between routes is not statistically significant. 4
Functional Improvement Benefits
Functional capacity improves from severe to moderate disability range, with 50-66% of patients achieving clinically meaningful improvement (≥10 points on Oswestry Disability Index) at 6 months. 4
Epidural injections reduce functional disability in the immediate term, though the effect size is small (standardized mean difference -0.33) and does not persist long-term. 2
Patients demonstrate improved ability to perform daily activities, with Oswestry scores improving from approximately 52-53% disability at baseline to 38-39% at 6 months. 4
Return to Work Benefits
- Approximately 70% of patients on medical leave return to work following epidural steroid injection treatment. 3
Surgical Avoidance Benefits
Epidural steroid injections reduce short-term surgery risk by 38% (relative risk 0.62), though this benefit does not extend to long-term surgical rates. 2
The procedure serves as part of a multimodal treatment regimen that may delay or prevent the need for surgical intervention in selected patients. 1, 5
Technical Considerations for Optimal Benefit
Fluoroscopic guidance is essential for proper needle placement and maximizing therapeutic benefit, particularly with transforaminal approaches. 1, 5
The transforaminal approach allows more precise medication delivery to the affected nerve root, which may explain its superior outcomes compared to other approaches. 6, 3
Important Limitations
Benefits do not meet predefined minimum clinically important difference thresholds in many studies, meaning the improvement may not be perceived as meaningful by all patients. 2
Pain relief and functional improvements are not sustained beyond 3-6 months, requiring consideration of repeat injections or alternative treatments. 2, 4
No evidence supports epidural steroid injections for non-radicular low back pain; benefits are specific to patients with true radiculopathy (pain radiating below the knee with nerve root compression on imaging). 1