Lumbar Epidural Steroid Injections for Chronic Spinal Pain: A Clinical Review of Efficacy and Evidence

Radicular pain and spinal stenosis are types of chronic lumbar spinal pain that contribute to major disability across the globe. Lumbar epidural steroid injections (LESIs) have been a primary intervention in these cases to reduce inflammation, relieve compressed nerve roots, and alleviate symptoms to avoid surgical treatments. Therefore, this review critically reviews and synthesizes up-to-date evidence on the safety, efficacy, and clinical usage of LESIs to manage chronic lumbar spinal pain, focusing especially on outcomes of different techniques and long-term effectiveness of LESIs. This study is a narrative clinical review evaluating high-quality literature from the year 2020 to 2025, focusing on academic medical centers for spinal care, orthopedic spine practices, and pain management clinics for outpatient interventions. The databases selected to collect literature for this comprehensive study were MEDLINE and PubMed, and the timeline was set from 2020 to 2025. Selected studies included cohort studies, randomized controlled trials, meta-analyses, and systematic reviews, which focused on the evaluation of the safety and efficacy of all types of LESIs. Data synthesis was qualitative and based on patients' medical condition (spinal stenosis, radiculopathy), LESI technique, short- and long-term results, and reported side effects. The majority of the studies reported impressive short-term results of LESIs, i.e., within four to 12 weeks of injections, in terms of pain relief and improved functionality, especially for transforaminal injections administered for lumbar radiculopathy. In lumbar spinal stenosis (LSS) cases, LESIs showed variable efficacy with slightly better short-term results. Literature showed inconsistency in long-term outcomes, i.e., over six months, and many cases required multiple injections. In terms of side effects, non-particulate steroids were the least problematic, with fewer serious complications in comparison. Overall, LESIs were found to be better as an effective and safe bridge therapy in many cases, but they could not be qualified as a curative option for most patients. Variability in injection techniques, heterogeneous study designs, and inconsistent criteria of patient selection restricted direct comparison of the selected studies. The majority of the studies were found in favor of short-term or intermediate-term benefits of LESIs, whereas very limited data were available on the long-term efficacy or optimal frequency of injections. LESIs are indeed effective for short-term benefits in lumbar radiculopathy and some spinal stenosis cases. Optimal outcomes depend on the LESI technique and patient stratification. Cumulative steroid risks need to be considered in case of the requirement for repeat injections. Evidence supports LESIs as being significantly more cost-effective than surgical interventions, and through quality-adjusted life years (QALYs) gained per intervention, LESIs may be the most cost-effective method for controlling early-stage LSS. LESIs should be integrated into a broader multimodal strategy to manage patients with LSS and lumbar radiculopathy.