Abstract

Epidural injections with or without steroids are used extensively in the man- agement of chronic spinal pain. However, evidence is contradictory with continuing de- bate about the value of epidural steroid in- jections in chronic spinal syndromes. The objective of this systematic re- view is to determine the effectiveness of epi- dural injections in the treatment of chronic spinal pain. Data sources include relevant literature identified through searchs of MED - LINE, EMBASE (Jan 1966- Mar 2003), manual searches of bibliographies of known primary and review articles, and abstracts from sci- entific meetings. Both randomized and non- randomized studies were included in the re- view based on the criteria established by the Agency for Healthcare Research and Quality (AHRQ). Studies were excluded from the anal- ysis if they were simply review or descriptive and failed to meet minimum criteria. The results showed that there was strong evidence to indicate effectiveness of transforaminal epidural injections in manag- ing lumbar nerve root pain. Further, evidence was moderate for caudal epidural injections in managing lumbar radicular pain. The ev- idence in management of chronic neck pain, chronic low back pain, cervical radiculopathy, spinal stenosis, and post laminectomy syn- drome was limited or inconclusive. In conclusion, the evidence of effective- ness of transforaminal epidural injections in managing lumbar nerve root pain was strong, whereas, effectiveness of caudal epidural in- jections in managing lumbar radiculopathy was moderate, while there was limited or in- conclusive evidence of effectiveness of epi- dural injections in managing chronic spinal pain without radiculopathy, spinal stenosis, post lumbar laminectomy syndrome, and cer- vical radiculopathy.

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