Practice Patterns of Physicians Who Perform Lumbar Interlaminar Epidural Steroid Injections: A Technical Survey

Area of Science:

• Pain Management
• Interventional Pain Procedures
• Spinal Injections

Background:

• Interlaminar epidural steroid injections (ESIs) are a common treatment for chronic spinal pain.
• Technical variations in ESI procedures may impact efficacy and safety.
• Lack of standardization in ESI techniques is a concern for interventional pain physicians.

Purpose of the Study:

• To examine practice patterns and technique variations in interlaminar ESIs among interventional pain physicians.
• To assess the clinical impact of different ESI techniques.
• To identify opportunities for standardization in interlaminar ESI procedures.

Main Methods:

• A questionnaire survey was distributed to interventional pain physicians performing ESIs.
• The survey collected data on practice parameters, including loss-of-resistance (LOR) techniques, epidural access methods, and contrast spread patterns.
• Data were analyzed from 92 physician respondents.

Main Results:

• Significant variability exists in LOR techniques (saline vs. air) and epidural access approaches (ipsilateral vs. paramedian).
• Physicians reported inconsistent achievement of bilateral contrast spread with midline interlaminar approaches.
• Wide variations in technique were observed across different practice settings and specialties.

Conclusions:

• Despite widespread use, interlaminar ESI techniques lack standardization.
• Identifying common practices is crucial for refining techniques and improving patient outcomes.
• Further research and consensus are needed to establish standardized guidelines for interlaminar ESIs.