Diagnosis-Specific Response to Corticosteroid Injections for Spinal Pain: A Real-World ODI-Based Analysis

of background data: Evidence regarding the efficacy of Epidural steroid injections (ESIs) in lumbosacral radicular syndrome (LRS) and their influencing factors, such as patient selection criteria, remains limited and therefore inconclusive (1).Inflammatory symptoms are logically relevant when administering a steroid (2), but it remains unclear whether these symptoms are considered in patient selection.Objectives: To examine the reporting of selection criteria in randomized controlled trials (RCTs) on ESI for LRS, focusing specifically on the inflammatory symptoms.Methods: PubMed, Embase, and Web of Science were searched until November 2024 to identify RCTs comparing ESI with non-invasive or sham interventions for patients with LRS.Two reviewers independently screened the studies for eligibility.Thematic synthesis was used to identify the themes and subthemes underlying patient selection criteria used in the included studies.A set of clinical symptoms was employed to assess the inclusion of inflammatory features in selection criteria (3).Results: Thirty-five RCTs met the inclusion criteria for this review based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework.Across these included studies, the most frequently reported patientlevel inclusion criteria were: 'duration' (77%), 'age' (66%), and 'disc pathology' (63%).Common patient-level exclusion criteria were: 'previous spinal surgery' (83%), 'breastfeeding' (71%), and 'neurological deficits' (66%).Specifications of these criteria varied widely across studies.None of the studies incorporated symptoms of inflammation in their selection criteria for ESI.Discussion/Conclusion: Selection criteria in RCTs evaluating ESI for LRS are heterogeneous and do not consider inflammatory symptoms.Inconsistent selection criteria limit definitive conclusions about ESI efficacy in LRS.This review provides recommendations to standardize reporting of selection criteria in studies of ESI for LRS patients. References:1. Hopayian K, Mugford M. Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?Br J Gen