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    The use of spinal injections have been in the news quite a lot lately and for all the wrong reasons. The recent cases of spinal meningitis contracted from spinal injections not withstanding, the effectiveness of spinal injections for low back pain (LBP) and sciatica has been debated for years. There are a number of published studies that examine how effective these injections really are.  A Google scholar search turns up articles dating back to the late 1980's. Most studies come to the same conclusion: Results from injections for LBP and/or sciatica offer at best temporary relief of symptoms to no effect what so ever. Some studies could not support the use of injections for treatment of chronic LBP at all. Others, found that it offered short term relief for the treatment of sciatica due to a herniated disc but did not provide significant functional benefit or reduce the need for surgery. One 1993 study recommended steroid injections based upon patients reports of satisfaction with their outcomes. However, the satisfaction surveys were done up to 3 months post. Most other studies have shown effects start to wear off around this time frame. It is not known by this author if surveys were repeated after 3 months.  

  So, if the effectiveness of spinal steroid injections is debatable why are so many done yearly? First of all, they do help some people, some of the time. They are also generally well tolerated by patients. Also in my experience, some patients are better able to tolerate physical therapy after having an injection. However I am not an advocate of injections as a stand alone treatment since most cases of LBP/Sciatica have a mechanical component and should be treated accordingly. For more information on the studies mentioned please reference the bibliography attached below.  

Ultimately the decision to have a spinal injection is up to the patient. Having enough information to make an educated choice may lead to better outcomes and more realistic expectations about success of the treatment. 

1) Use of Epidural Steroid Injections to Treat Radicular Lumbosacral Pain. Armon, C MD et al. Neurology, March 6 2007 Vol. 68 no. 10

2) Outpatient Lumbar Epidural Corticosteroid Injection in the Management of Sciatica. Ridley, M.G. et al. Rheumatology 1998 27(4)

3) Efficacy of Epidural Steroid Injections for Low Back Pain and Sciatica: A Systematic Review of Randomized Clinical Trials. Koes, B et al. Pain December 1995, Volume 63, Issue 3

4) Epidural Corticosteroid Injections for Sciatica Due to Herniated Nucleus Pulposis. Carette, S MD et al. New England Journal of Medicine June 1997

5) A Controlled Trial of Corticosteroid Injections into Facet Joints for Chronic Low Back Pain.  Carette, S MD et al. New England Journal of Medicine October 1991 

 Also visit these websites for more information:

www.spine-health.com

www.aaos.org   

American Academy of Orthopedic Surgeons

www.spine.org