Epidural steroids

Epidural steroid injections (ESIs) are an historical therapy, the use of which is now understood to be related to the need for steroids to diminish the inflammatory reaction in nerve roots precipitated by PLA-2 spilled from the nucleus pulposus. Patients who receive ESIs should be actively chosen for such therapy after the distillation of historical, physical examination, and laboratory data suggest that nerve root irritation is causative or at least contributory. Many physical and nonphysical factors influence the selection of patients. Animal research models have established the tissue safety of ESIs, and clinical reports document the utility of the intervention when it is used as a component of an integrated therapeutic program. Responsive medical follow-up examinations are crucial to the safe application of ESIs and to guide the use of additional treatment options when indicated.