What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

5 randomized controlled trials were used in this systematic review assessing the efficacy of lumbar epidural injections in the management of discogenic pain as compared to lumbar fusion. In trials of epidural injections with local anaesthetic, and patients randomized to intervention with and without steroids, minimum 50% improvement in pain and function was demonstrated at rates of between 54-72%. In randomized trials comparing lumbar fusion to traditional conservative management options (ie. physical therapy), one study demonstrated a small by significant difference in favour of surgery for pain and functional outcome within 1-2 year follow-up, whereas the remaining two studies reported no significant differences between groups from 2-4 year follow-up. Meta-analysis was not performed due to the lack for studies directly comparing epidural injection and lumbar fusion.