Section 1 of 6
Choose the clinical goal
Link the symptoms, imaging and intended benefit.
Risks and benefits
Intended benefit
The goal is relief of concordant radicular pain and improved function. Pooled ESI evidence supports mainly short-term benefit; long-term pain relief remains uncertain. Benefit varies with the indication and is not established by a technically successful injection.
Risks and tradeoffs
Discuss bleeding, infection, medication reactions, dural puncture and unintended neural or vascular injection. Rare serious neurological events include stroke, paralysis and death. Epidural corticosteroid administration is an off-label route.
Make the decision together
Review the access level and dorsal epidural space on the patient’s imaging. Discuss alternatives and a measurable functional goal; the symptomatic level alone does not select the access window. Compare rehabilitation, medication and other appropriate care. Set a functional goal and reassessment plan. For chronic radicular pain, discuss the differing AAN evidence summary and BMJ recommendation against injections; their questions and scope differ.