• Anil K Sharma, Yakov Vorobeychik, Ronald Wasserman, Jessica Jameson, Maxim Moradian, Belinda Duszynski, David J Kennedy, and Standards Division of the Spine Intervention Society.
• Spine and Pain Centers, Shrewsbury, New Jersey, NJ, USA.
• Pain Med. 2017 Feb 1; 18 (2): 239-251.

ObjectiveTo determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections.DesignSystematic review of the literature with comprehensive analysis of the published data.InterventionsThree reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented.Outcome MeasuresThe primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence.ResultsThe search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies.ConclusionsThe body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant short-term improvement in pain.

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