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.