Epidural steroid injections: Evidence and technical aspects

Employing epidural steroid injections has become common practice in numerous pain management clinics around the world. Reviews have provided evidence supporting such practice in some patients suffering chronic pain. Nevertheless, several techniques exist to inject different combinations of steroids and local anesthetics in the epidural space of a patient, including the caudal approach, the translaminar approach, and the transforaminal approach. Also available are several different steroid preparations that are used regularly. Choosing one technique over another, or choosing the appropriate steroid and dose and an image guidance to confirm the accurate and safe injection of the medication in the proper target could have repercussions in the course of the recovery of the patient in chronic pain. This paper presents a brief summary of the available evidence supporting the use of epidural steroid injections. It also analyzes physical and technical aspects as far as the used approach to the epidural space, medicines, and the image guidance techniques used to verify the precise and safe injection of the medication in the selected target.