Author Affiliations: Department of Rehabilitation Medicine, University of Washington, Seattle (Dr Friedly); Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, Oregon Health and Science University, Portland (Dr Deyo).
Low back disorders are extremely common and account for an important (and growing) proportion of medical expenditures.1 Their prevalence and impact have led to an expanding array of treatments, including spinal injections, implantable devices, and surgical procedures. Over the last 15 years, there has been a dramatic increase in the use of many of these treatments, including epidural steroid injections.2 However, wide geographic variations in the use of such injections suggest professional uncertainty as to optimal indications.3 Along with increasing use of these treatments, there has been a rapid increase in the use of advanced spinal imaging.4 Despite these trends, overall quality of life for people reporting back pain does not seem to be improving over time.1
Friedly J, Deyo RA. Imaging and Uncertainty in the Use of Lumbar Epidural Steroid InjectionsComment on “Effect of MRI on Treatment Results or Decision Making in Patients With Lumbosacral Radiculopathy Referred for Epidural Steroid Injections”. Arch Intern Med. 2012;172(2):142-143. doi:10.1001/archinternmed.2011.581