Spinal Injection Therapies: Epidural Injections
The nerves from the brain to the body run down a canal inside the backbone. The bones surround and protect the nerves. The space between the nerves and the bones is called the epidural space.
Injections into the epidural space have been used to treat patients for persistent neck and back pain. Usually steroid and local anaesthetic are used.
This report looked at research studies to see whether epidural injections are safe and useful.
Some research studies are specifically designed to test whether a treatment is helpful or not and the results are trustworthy. These studies are called high level evidence. Other studies are not designed to test the treatment, but just observe what happened to patients who received it or to those who did not. These studies can provide some information, but it is not as certain as the information from high level evidence.
These studies are referred to as low level evidence, sometimes called observational studies.
1. Cervical epidural injections
(Cervical relates to the neck)
One relevant guideline that assessed the usefulness of cervical epidural injections for whiplash-associated neck pain was found. Guidelines are written by a group of specialists and based on research. This guideline was unable to identify any research. This does not mean that cervical epidural injections are not helpful, it just means that no research studies have proven that they are.
A report that looked at the complications of cervical epidural injections found that there were no major problems. Side effects occurred in a small number of patients. The authors decided that care and caution were needed when doing cervical epidural injections.
2. Thoracic epidural injections
(Thoracic relates to the upper back)
No relevant studies that assessed the usefulness of thoracic epidural injections for upper back pain were found. This does not mean that these injections are not helpful; it just means that no research studies have proven that they are.
3. Lumbar epidural injections
(Lumbar relates to the lower back)
One good quality trial had inconsistent results. Immediately after treatment, patients who had injections of steroids plus local anaesthetic had more relief of leg pain than those who did not. There was no difference in back pain. At three months there was no difference in leg pain but back pain was worse in the patients who had the treatment. By six months both leg and back pain were worse in those who had the treatment. One year after treatment there was no difference between the two groups.
The patients who had injections of steroids plus local anaesthetic had better function three months after treatment than those who did not. There was no difference in function between the two groups one year after the injections.
There was no difference in quality of life, sick leave, use of medication or use of health care services between the two groups up to one year after treatment.
A report that looked at complications of lumbar epidural injections found that there were no major complications. Side effects occurred in a small number of patients. The authors decided that care and caution were needed when performing epidural injections.