Epidural injection with corticosteroids is a common treatment option for patients with lower back pain or sciatica. In this paper we review its origin and evolution. The first injections were given around 1900 in Paris by Jean Sicard (1872-1929) and Fernand Cathelin (1873-1945), who worked independently. They both injected small volumes of cocaine into the sacral hiatus. After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America. In the early 1950s, corticosteroids were introduced for epidural use. Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term. Despite an ongoing debate about effectiveness and safety, epidural injections remain popular.

Keywords:
Back pain, Sciatica, Pain treatment, Epidural injections, History, Corticosteroids, Debate
1.
Bicket MC, Chakravarthy K, Chang D, Cohen SP: Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag 2015;5:129-146.
2.
Manchikanti L, Falco FJ, Singh V, et al: Utilization of interventional techniques in managing chronic pain in the Medicare population: analysis of growth patterns from 2000 to 2011. Pain Physician 2012;15:E969-E982.
3.
Sicard MA: Les injections médicamenteuses extradurales par voie sacrococcygienne. C R Seances Soc Biol Fil 1901;53:396.
4.
Corning JL: Spinal anaesthesia and local medication of the cord. N Y Med J 1885;42:483-485.
5.
Gorelick PB, Zych D: James Leonard Corning and the early history of spinal puncture. Neurology 1987;37:672-674.
6.
Bier A: Versuche über cocainisirung des rückenmarkes. Deutsche Zeitschrift für Chirurgie 1899;51:361-369.
7.
Sicard JA: Le Liquide céphalo-rachidien, recherches expérimentales et cliniques. Paris, Masson et cie., 1900.
8.
Cathelin F: Une nouvelle voie d'injection rachidienne: méthode des injections épidurales par le procédé du canal sacre - applications à l'homme. Compt Rend Soc de Biol 1901;53:452-453.
9.
Cathelin F: Les Injections Epidurales et Leurs Applications Dans les Maladies des Voies Urinaires. Paris, Baillière et fils, 1903.
10.
Steimlé R: Jean A. Sicard (1872-1929). J Neurol 2013;260:1946-1947.
11.
Koehler PJ: Lessons from peripheral nerve injuries; causalgia in particular; in Fine E (ed): History Course. Lessons from War. San Diego, American Academy of Neurology, 2013.
12.
Sicard JA, Forestier J: Méthode radiographique d'exploration de la cavité épidurale par le Lipiodol. Rev Neurol 1921;2:1264.
13.
Sicard JA, Forestier J: Roentgenologic exploration of the central nervous system with iodised oil (lipiodol). Archives Neur Psych 1926;16:420-434.
14.
Gawande A: Slow Ideas. The New Yorker, 2013.
15.
Viner N: Intractable sciatica. The sacral epidural injection; an effective method of giving relief. Can Med Assoc J 1925;15:630-634.
16.
Mixter WJ, Barr JS: Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934;211:210-215.
17.
Evans W: Intrasacral epidural injection in the treatment of sciatica. Lancet 1930;216:1225-1228.
18.
Clapsattle H: The Doctors Mayo, ed 2. Rochester, Mayo Clinic Press, 1969, p 376.
19.
Kendall EC: Some observations on the hormone of the adrenal cortex designated compound E. Proc Staff Meet Mayo Clin 1949;24:298-301.
20.
Robecchi P, Capra AL: L'idrocortisone (composto F), prime esperienze cliniche in campo reumatologico. Minerva Med 1952;2:1259-1263.
21.
Lièvre JA, Bloch-Michel H, Pean G, et al: L'hydrocortisone en injection locale. Rev Rhum Mal Osteoartic 1953;20:310-311.
22.
Goebert HW Jr, Jallo SJ, Gardner WJ, et al: Sciatica: treatment with epidural injections of procaine and hydrocortisone. Cleve Clin Q 1960;27:191-197.
23.
Nelson DA, Landau WM: Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports. J Neurol Neurosurg Psychiatry 2001;70:433-443.
24.
Brown JH: Pressure caudal anesthesia and back manipulation. Conservative method for treatment of sciatica. Northwest Med 1960;59:905-909.
25.
Winnie AP, Hartman JT, Meyers HL Jr, et al: Pain clinic. II. Intradural and extradural corticosteroids for sciatica. Anesth Analg 1972;51:990-999.
26.
El-Khoury GY, Ehara S, Weinstein JN, et al: Epidural steroid injection: a procedure ideally performed with fluoroscopic control. Radiology 1988;168:554-557.
27.
Rosen CD, Kahanovitz N, Bernstein R, et al: A retrospective analysis of the efficacy of epidural steroid injections. Clin Orthop Relat Res 1988;228:270-272.
28.
Power RA, Taylor GJ, Fyfe IS: Lumbar epidural injection of steroid in acute prolapsed intervertebral discs. A prospective study. Spine (Phila Pa 1976) 1992;17:453-455.
29.
Bowman SJ, Wedderburn L, Whaley A, et al: Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine (Phila Pa 1976) 1993;18:1345-1350.
30.
Gardner WJ, Goebert HW Jr, Sehgal AD: Intraspinal corticosteroids in the treatment of sciatica. Trans Am Neurol Assoc 1961;86:214-215.
31.
Sehgal AD, Gardner WJ, Dohn DF: Pantopaque ‘arachnoiditis' treatment with subarachnoid injection of corticosteroids. Cleveland Clinic Quarterly 1962;29:177-188.
32.
Dilke TF, Burry HC, Grahame R: Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 1973;2:635-637.
33.
Snoek W, Weber H, Jorgensen B: Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs. Acta Orthop Scand 1977;48:635-641.
34.
Schaufele MK, Hatch L, Jones W: Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician 2006;9:361-366.
35.
Pinto RZ, Maher CG, Ferreira ML, et al: Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med 2012;157:865-877.
36.
Atkins D, Best D, Briss PA, et al; GRADE Working Group: Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.
37.
Botwin KP, Gruber RD, Bouchlas CG, et al: Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000;81:1045-1050.
38.
Epstein NE: The risks of epidural and transforaminal steroid injections in the Spine: commentary and a comprehensive review of the literature. Surg Neurol Int 2013;4(suppl 2):S74-S93.
39.
El-Yahchouchi CA, Plastaras CT, Maus TP, et al: Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: a multi-institutional study. Pain Med 2015, Epub ahead of print.
40.
Plastaras C, McCormick ZL, Garvan C, et al: Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J 2015;15:2157-2165.
41.
Abram SE, O'Connor TC: Complications associated with epidural steroid injections. Reg Anaesth 1996;21:149-162.
42.
Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N: Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med 2009;10:1389-1394.
43.
Somayaji HS, Saifuddin A, Casey AT, Briggs TW: Spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection. Spine (Phila Pa 1976) 2005;30:E106-E108.
44.
Deshpande DM, Krishnan C, Kerr DA: Transverse myelitis after lumbar steroid injection in a patient with Behcet's disease. Spinal Cord 2005;43:735-737.
45.
Lyders EM, Morris PP: A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol 2009;30:1691-1693.
46.
Malani AN, Vandenberg DM, Singal B, et al: Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate. JAMA 2013;309:2465-2472.
47.
Rathmell JP, Benzon HT, Dreyfuss P, et al: Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology 2015;122:974-984.
48.
Benzon HT, Huntoon MA, Rathmell JP: Improving the safety of epidural steroid injections. JAMA 2015;313:1713-1714.
50.
Manchikanti L, Candido KD, Singh V, et al: Epidural steroid warning controversy still dogging FDA. Pain Physician 2014;17:E451-E474.
51.
Candido KD, Knezevic NN, Chang-Chien GC, Deer TR: The Food and Drug Administration's recent action on April 23, 2014 failed to appropriately address safety concerns about epidural steroid use. Pain Physician 2014;17:E549-E552.
53.
Merton RK: Priorities in scientific discovery: a chapter in the sociology of science. Am Sociol Rev 1957;22:635-659.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.