Select the patient

Connect the symptoms, examination and imaging before choosing an injection.

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

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.

Start with the clinical question

A referral requests an L5–S1 injection. The MRI describes several abnormal discs. What must you resolve first?

The symptomatic root and sideA standard needle entry pointThe most abnormal disc on the report

Why this matters

A disc level, a symptomatic nerve root and an access level are different pieces of the plan.