Spinal epidural injections

For the treatment of

Low back pain with Sciatica

Commissioning position

These interventions are commissioned if:

the patient has radicular leg pain (below the knee for lower lumbar herniation, into the anterior thigh for upper lumbar herniation) consistent with the level of spinal involvement AND
patient is in the early clinical course for symptom control AND
clinician and patient reach agreement for therapeutic injection for moderate or severe lumbosacral radicular pain (compressive or inflammatory) AND
alternative treatments are unsuitable or not tolerated (e.g. patient unfit for surgery/poorly defined surgical target/patient unable to tolerate neuropathic pain medications}.

Epidural injections are not commissioned for neurogenic claudication caused by central spinal canal stenosis.

Epidural injections are not commissioned for the treatment of non-specific low back pain.

Summary of rationale

Injection of depot preparations of steroid usually with local anaesthetic has an established value in a variety of acute and chronic pain problems associated with inflammatory, compressive or post-surgical pathology in the lumbosacral spine, where leg pain is the predominant symptom.