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Predicting epidural steroid injections with laboratory markers and imaging techniques
Benoy V Benny1, Monika Yogesh Patel2
1Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Medical Center, McNair Campus, 7200 Cambridge St, Suite 10C, Houston, TX 77030, USA.
Summary
Predictive tools for epidural steroid injections (ESIs) show promise for radicular pain. Elevated interferon gamma (IFN-γ) may predict short-term pain relief, but more research is needed.
Area of Science:
- Pain Management
- Interventional Pain Medicine
- Neurosurgery
Background:
- Epidural steroid injections (ESIs) are utilized for radicular pain stemming from nerve root impingement or stenosis.
- ESIs are considered after conservative treatments like oral medications and physical therapy have failed.
Purpose of the Study:
- To evaluate the prognostic accuracy of various predictive tools for outcomes of epidural steroid injections (ESIs) in managing radicular pain.
Main Methods:
- A systematic review of fifty PubMed-sourced articles was conducted.
- Inclusion criteria focused on radicular pain, specific prediction tools, and pain/function outcomes.
- Eight articles on imaging or laboratory markers underwent quality evaluation per AAN guidelines.
Main Results:
- Insufficient evidence exists regarding imaging of spinal stenosis for predicting ESI outcomes.
- Low-grade nerve root compression may predict short-term pain reduction after transforaminal ESI.
- Elevated interferon gamma (IFN-γ) in epidural lavage fluid likely predicts short-term pain reduction following lumbar ESI.
Conclusions:
- Predictive tools like nerve root compression grading and inflammatory markers, especially IFN-γ, show future potential for ESI outcomes.
- Further research with larger cohorts, diverse patient populations, and standardized outcome measures is required before clinical recommendations can be made.
