Preprocedural Imaging Review Before Performing Epidural Steroid Injections: Analysis of Physician Practice Parameters

Introduction: Epidural steroid injections (ESIs) are a common interventional treatment for managing spinal pain complaints. Despite their widespread use, practice patterns among physicians performing ESIs vary significantly. This study aimed to evaluate preprocedural imaging review by pain physicians who perform ESIs in the cervical, thoracic, and lumbar spine. Methods: A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding preprocedural imaging review before performing ESIs in the cervical, thoracic, and lumbar spine. The respondents included a diverse group of pain management physicians from various specialties and practice settings. Results: The results revealed that the majority of interventional pain management physicians personally interpret their own imaging, followed by a significant percentage of physicians who rely on the radiology reports. There were no physicians who did not perform any imaging review prior to ESIs. Whereas all respondents reported some form of imaging review, only 63.86%, 53.75%, and 64.44% reviewed the actual images prior to cervical, thoracic, and lumbar access, respectively. Conclusions: This survey provides initial data regarding imaging reviews among physicians who perform ESIs. Our results demonstrate that physicians treat imaging review as an essential component of the preprocedural process for performing ESIs, as all physicians reported that they perform some form of imaging review before performing ESIs. However, there is only partial adherence to the multidisciplinary working group opinion that segmental imaging should be reviewed for adequacy of space prior to cervical epidural access.