The Role of Interlaminar and Transforaminal Epidural Steroid Injections for Discogenic Low Back Pain without Radiation

Background: Transforaminal and Interlaminar Epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections in the treatment of lumbar discogenic back pain. Study Design: A systematic review of interlaminar and transformainal epidural injections with or without steroids in managing chronic low back pain of dicogenic origin. Objective: To evaluate the effect of transforaminal and interlaminar epidural injection epidural injections with or without steroids in discogenic back pain. Methods: A literature review was performed using PubMed, EMBASE from 1966 - December 2012, Cochrane database, Clinical Trial Registry, previous systematic reviews and cross references published in the English language. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Outcome Measures: The primary outcome measure was pain relief (shortterm relief = up to 6 months and long-term > or = 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results: The evidence level II-2 for interlaminar epidural steroid injection for short term pain relief for lumbar discogenic back pain and level II-3 for transforaminal epidural steroid injection for short term pain relief for lumbar discogenic back pain. Limitations: The limitations of this study include the paucity of literature and lack of randomized controlled trials. Conclusion: The results of this systematic evaluation for the treatment of discogenic pain of indicated evidence levels of level II-2 for interlaminar injections and level IIIfor transforaminal injections.