What is the efficacy of epidural steroid injections in cervical osteophyte (bone spur) formation and lumbar (lower back) or cervical (neck) radiculopathy (nerve root disease)?

From the Guidelines

Epidural steroid injections (ESIs) have limited efficacy in treating cervical ossification of the posterior longitudinal ligament (OPLL) and should be considered only for temporary symptom relief in select patients. The primary benefit of ESIs in cervical OPLL is short-term reduction of inflammatory pain and radicular symptoms, typically lasting 2-12 weeks, as supported by moderate certainty evidence from the 2025 BMJ study 1. However, they do not address the underlying mechanical compression caused by the ossified ligament. ESIs are most appropriate for patients with mild to moderate symptoms who are not surgical candidates or who need temporary relief while awaiting definitive treatment.

Some key points to consider when evaluating the efficacy of ESIs in cervical OPLL include:

• The anti-inflammatory effect of steroids reduces swelling around compressed nerve roots, temporarily improving symptoms, but the progressive nature of OPLL means that surgical decompression is often eventually required for patients with significant cord compression or progressive neurological deficits.
• Patients should be aware that multiple injections (typically limited to 3-4 per year) may increase risks including infection, bleeding, nerve damage, and spinal cord injury, which are particularly concerning in the cervical spine with pre-existing OPLL, as reported in the 2025 BMJ study 1.
• The 2019 study from the Journal of the American College of Radiology 1 provides guidance on the evaluation and treatment of cervical neck pain, but does not specifically address the efficacy of ESIs in cervical OPLL.
• The 2007 study from the Annals of Internal Medicine 1 provides recommendations for the diagnosis and treatment of low back pain, but is not directly applicable to cervical OPLL.

In terms of specific treatment protocols, ESIs typically contain a corticosteroid (such as methylprednisolone 40-80mg, triamcinolone 40-80mg, or dexamethasone 4-10mg) combined with a local anesthetic (like lidocaine 1-2% or bupivacaine 0.25-0.5%). However, the decision to use ESIs should be based on a thorough evaluation of the patient's symptoms, medical history, and potential risks and benefits, as well as consideration of alternative treatment options, such as surgical decompression.

From the Research

Efficacy of Epidural Steroid Injections in Cervical OPLL

• The efficacy of epidural steroid injections in cervical ossification of the posterior longitudinal ligament (OPLL) is a topic of debate, with some studies suggesting that these injections provide no long-term benefit and carry significant risks and complications 2.
• A study published in 2022 found that epidural steroid injections can be an effective treatment for radicular pain, but the risks and efficacy data vary between different routes of injection and underlying pathology 3.
• Another study published in 2023 found that cervical steroid injections are not effective in preventing surgical treatment of degenerative cervical myelopathy, and may even be associated with higher odds of surgery within 1 year 4.
• The use of epidural steroid injections in cervical OPLL is not FDA approved, and these injections are often performed for minimal to no indications, contributing to significant morbidity and mortality 2.
• A study published in 2024 outlined recommendations to minimize risks associated with cervical epidural injections, including performing injections at the C6-C7 or below level, using a paramedian approach, and confirming minimal needle insertion depth with imaging 5.

Risks and Complications

• Epidural steroid injections in cervical OPLL carry significant risks and complications, including epidural hematomas, infection, increased neurological deficits, and intravascular injections leading to strokes 2.
• The use of particulate steroid matter in injections can embolize into distal arterial branches, leading to catastrophic complications such as cord, brain stem, and cerebellar strokes 2.
• The risk of complications can be minimized by following proper injection techniques, using imaging guidance, and carefully selecting patients for injection therapy 5.

Clinical Considerations

• The decision to use epidural steroid injections in cervical OPLL should be based on a patient's clinical presentation, pathology, anatomy, and consideration of the natural course of pain, as well as the unique risks and benefits of the particular technique 3.
• Patients with degenerative cervical myelopathy may require prompt referral to a spine surgeon, as delayed diagnosis and management can result in long-term disability 6.
• The use of epidural steroid injections in cervical OPLL should be carefully considered, taking into account the potential risks and benefits, as well as the availability of alternative treatment options 4.