The New S3 Guideline on "Epidural injections"

Epidural injections are frequently performed for radicular pain. The German Society for Spine Surgery (DWG) published an S3 guideline for assessing benefits and performing epidural injections. The goal is to standardize the indication, technique, and medication selection based on evidence.

The guideline was developed with the participation of ten professional associations and a patient representative using the AGREE II tool. It was based on a systematic literature review with GRADE assessment. Fourteen PICO questions were addressed.

The evidence varies greatly depending on the approach and region. Transforaminal injections are recommended for radicular pain. Interlaminar injections have been shown to have a short-term effect for radicular pain in the lumbar spine. All randomized benefit assessment studies used fluoroscopy for transforaminal injections. CT or ultrasound scanning is also possible. Particulate steroids and preparations containing potentially neurotoxic preservatives should be avoided due to the potential for serious complications. Neurological follow-up and patient feedback are important. Repeat injections are only indicated if there has been a prior response. Series of injections without assessing the efficacy should not be performed.

The new S3 guideline provides practical, evidence-based recommendations for the safe performance of epidural injections. It offers important guidance on indication, technique, and drug selection. Individual medical assessment remains essential.

· Periradicular therapy (PRT) is an image-guided transforaminal injection into the epidural space at a defined nerve root.. · The standard is fluoroscopy. The use of CT scanning is also possible.. · Non-particulate steroids (dexamethasone) are preferable due to lower complication rates.. · Neurological examination and monitoring of the patient is important after an intervention.. · A repeat transforaminal injection should only be performed if a positive response was previously found..

· Klessinger S. The New S3 Guideline on "Epidural injections". Rofo 2025; 10.1055/a-2702-4560.