Lumbar epidural steroid injections (LESIs) remain a popular minimally invasive option to reduce nerve-root inflammation and buy time before—or instead of—surgery. A 2025 narrative review published in Cureus by Soin et al. synthesized the latest evidence on LESIs’ real-world performance from 2020 to 2025.
The authors concluded that LESIs function best as a ‘bridge therapy’ within a multimodal treatment plan rather than a cure. They offer cost-effectiveness compared with early surgery and improvements in both the length and quality of life, particularly in early lumbar spinal stenosis, and appear more effective when inflammation rather than mechanical compression is the primary driver.
The review included randomized-controlled trials, cohorts, meta-analyses, and prior systematic reviews that focused on adults with radiculopathy or lumbar spinal stenosis treated via transforaminal, interlaminar, or caudal approaches. Twenty-four studies were included in analysis. One key takeaway is lumbar injections delivered short-term relief (four to 12 weeks), especially when a transforaminal approach is used for targeted radicular pain.
- Transforaminal injection: The needle enters from the side of the spine through the neural foramen to deliver medication directly adjacent to a specific irritated nerve root.Best for: Radicular pain or sciatica from disc herniation or focal foraminal stenosis that only affects one side of the body; offers the highest precision and targeted relief.
- Interlaminar injection: The needle is inserted posteriorly between the laminae of adjacent vertebrae into the central posterior epidural space, allowing broader medication spread.Best for: More diffuse low back pain with radiculopathy or spinal stenosis or radicular pain that affects both sides of the body. Simpler technique with moderate selectivity.
- Caudal injection: The needle enters through the sacral hiatus at the base of the sacrum, with medication flowing upward into the lower lumbar epidural space.Best for: Multilevel pathology, post-surgical patients with scar tissue, or when a safer entry point is needed. Least precise for targeting specific nerves but has lower risk of nerve or vascular injury.
Patients often see Numeric Pain Rating Scale (NPRS) scores decrease from 6.8 to 3.5 and Oswestry Disability Index improvements from 44 to 29 at 12 weeks. Success rates can be as high as 70–90% in the short term for radiculopathy while lumbar spinal stenosis shows more variable—but positive—early gains in mild to moderate cases. Many people with spinal stenosis saw pain reduction greater than 50%.
After six months, the results are less consistent. Many patients require repeat injections with 20–91% needing additional procedures or adjunct therapies, according to Soin et. al
Technique also seems to matter. Transforaminal injection generally outperforms interlaminar or caudal injections in both precision and short-term pain reduction at 64–66% decrease in pain score vs. 52% decrease, respectively. All approaches have been shown to be less effective over time. Non-particulate steroids appear safest with fewer serious complications.
The bigger picture
Chronic low back pain and associated radiculopathy or lumbar spinal stenosis disable millions worldwide, driving up healthcare costs and limiting daily function. Low back pain affected 619 million people worldwide in 2020 and remains the leading global cause of years lived with disability, generating enormous direct healthcare costs.
In the U.S. alone, an estimated $315 billion for spine-related expenditures from 2012–14. These direct costs are accompanied by substantial indirect costs from lost productivity and work absenteeism.
A landmark work by Chou et al. in 2015 found moderate short-term pain and function benefits for radiculopathy but only small, clinically-questionable effects for spinal stenosis. Long-term improvements (more than three to six months) were minimal or absent compared with placebo.
Oliveira et al. echoed this in 2020 when his work concluded that epidural steroids add little beyond local anesthetic alone for chronic radicular pain, with effects fading by three to 12 months.
Manchikanti et al. authored multiple reviews between 2016 and 2021 that reported stronger evidence for short- and some intermediate-term relief, particularly when comparing steroids plus anesthetic versus anesthetic alone. Also, these reviews highlighted transforaminal approaches.
Other studies include:
- A 2023 meta-analysis in PAIN Practice ranked parasagittal interlaminar and transforaminal highest for short- and long-term pain reduction.
- A 2025 systematic review in Practical Neurology of 90 randomized-controlled trials continues to affirm modest short-term gains for radiculopathy and disability reduction in stenosis but stress heterogeneity, patient selection, and the lack of curative impact.
Large population-based trials in older adults or post-surgical cohorts similarly show initial relief that often requires repeats and rarely alters long-term trajectories without physical therapy or lifestyle changes. Guidelines can vary: Some endorse LESIs for refractory radiculopathy, or “pinched nerves,” while others caution against routine use in nonspecific chronic low back pain and stenosis.
Why this review now, and what it means for clinicians?
This review is as timely as ever given society’s focus on rising health care costs. It’s critical that patients are discussing options with their health care practitioners and making educated decisions regarding their care. This review helps answer several common questions regarding the effectiveness of these treatment options.
Earlier meta-analyses left clinicians and patients with conflicting messages on long-term efficacy, optimal technique, steroid choice, and repeat-injection safety. As interventional pain experts seeing thousands of low back pain cases annually, they aimed to give practicing physicians an updated, technique-specific roadmap drawn from the most recent academic and outpatient data.
The review’s relevance is clear: Lumbar injections are performed millions of times yearly, yet many patients (and their respective physical therapists) wonder whether they’re a temporary bridge or false hope.
What is clear from this review?
- For physical therapists: The evidence supports using the short-term “window” of reduced pain, often four to 12 weeks, to intensify manual therapy, strengthening, and functional training, especially for those with radiculopathy. Those with clear MRI-confirmed foraminal stenosis or disc herniation fare better than diffuse nonspecific low back pain or advanced stenosis with mechanical compression.
- For patients: Cumulative steroid exposure raises risks (adrenal suppression, bone density loss, infection), so non-particulate formulations and limiting frequency are key. A single injection is unlikely to be curative as the data show. It’s a bridge, not a fix. The best results come from transforaminal injections under fluoroscopy for unilateral radicular pain. Those with multi-level or post-surgical pain may be better candidates for caudal injections.
- Shared decision-making: Lumbar injections are more cost-effective short-term and avoid operative risks for many, but long-term function depends on addressing root causes (posture, core strength, ergonomics).
Bottom line for practice
Soin et al. reported what earlier analyses have shown: Lumbar injections provide reliable short-term pain relief and functional gains, particularly transforaminal approaches for radiculopathy, making them a valuable, safe tool when used in the right patient at the right time. They do not replace physical therapy, a healthy lifestyle, or address biomechanical issues and they do not guarantee lasting resolution.
For patients frustrated by persistent low back pain and for physical therapists guiding recovery, the message is hopeful yet realistic. Expect meaningful relief in the first 12 weeks, but plan for a multimodal follow-through and reserve repeated visits based on individual response rather than routine scheduling. Future high-quality randomized-controlled trials with standardized techniques and long-term follow-up will further clarify the role of this popular intervention.
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.
