Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update

Lumbar transforaminal and interlaminar epidural steroid injections are widely used to treat patients with radicular pain and radiculopathy [1]. These lumbar spine procedures are reported to be clinically effective for short-term and long-term pain relief by some studies [2–5]. However, a relative lack of randomized and controlled clinical trials and as well as variability of the employed study methods were noted [6]. Thus, some controversy concerning the effectiveness of lumbar transforaminal and interlaminar epidural steroid injections still remains [6, 7]. Moreover, it should be emphasized that these indications and use are often performed on an off-label basis. The question arises whether just formal approval is lacking or whether extensive medical literature provides sufficient evidence-based efficacy and safety data for this off-label use. An image-guided therapeutic injection of both the cervical and lumbar spine is a minimally invasive technique, however rare serious adverse events such as brainstem, cerebellum and cervical, thoracic and lumbar spinal cord infarction have occurred [8–26]. The present article discusses serious complications associated with epidural steroid injections after injections at the level of the lumbosacral spine