People with symptomatic central spinal canal stenosis should not have epidural injections for neurologic claudication.
NICE 2016. Low back pain and sciatica in over 16s: assessment and management. NICE Guideline [NG59] November 2016. Available at: https://www.nice.org.uk/guidance/NG59
Consider epidural injections of local anaesthetic and steroid in people with acute and severe sciatica.
Do not use epidural injections for neurogenic claudication in people who have central spinal canal stenosis.
NHMRC Australian Acute Musculoskeletal Pain Guidelines Group 2003. Evidence-based Management of Acute Musculoskeletal Pain. Available at: https://www.nhmrc.gov.au/
Injection Therapy — There is insufficient evidence demonstrating the effectiveness of injection therapy (facet joint, epidural or soft tissue) in the treatment of acute low back pain. Adverse effects of injection therapy are rare but serious.
Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, Johnson K, Kramer C, Mueller B, Peterson S, Setterlund L, Timming R. Institute for Clinical Systems Improvement. Adult Acute and Subacute Low Back Pain. Updated November 2012.
Epidural steroid injections may be used for low back pain, with a radicular component to assist with short-term pain relief.
TOP 2015. Toward Optimised Practice - Evidence-Informed Primary Care Management of Low Back Pain: Clinical Practice Guidelines. 3rd Edition. December 2015. Institute of Health Economics, Alberta, Canada.
DO NOT use epidural steroid injections for acute low back pain in the absence of radiculopathy
Low Back Pain: Medical Treatment Guidelines. July 2007. Department of Labor and Employment, State of Colorado, USA.
Spinal Stenosis Patients:
a. Patients with radicular findings: When the patient has documented spinal stenosis, has completed 6-8 weeks of active therapy, has persistent radicular findings and difficulty with some activities, thus meeting criteria for surgical intervention, the patient may have one diagnostic injection. Because stenosis is not likely to change anatomically, unlike herniated discs which recede overtime, and due to the success rate of surgery for this condition in most cases, early surgical consultation is encouraged whenever the patient remains symptomatic after conservative therapy. If the patient does not wish to have a surgical intervention two additional injections may be provided if the original diagnostic intervention was successful per guideline standards.
b. Patients with claudication: The patient has documented spinal stenosis, has completed 6-8 weeks of active therapy, has persistent claudication symptoms and difficulty with some activities, thus meeting criteria for surgical intervention. The patient may have one diagnostic injection. Patients who have any objective neurologic findings should proceed as the above patient with radicular findings for whom an early surgical consultation is recommended.