Ask the Experts: Epidural Steroid Injections — Not As Simple As You'd Think! - Podcast 20

In Episode 20, “Epidural Steroid Injections — Not As Simple As You'd Think!”, our experts covered your questions on:

• Which patient phenotypes and pain generators are most predictive of meaningful clinical response?
• When, if ever, is ESI appropriate for isolated axial back pain?
• How should interlaminar vs. transforaminal approaches be selected based on anatomy, pathology, and therapeutic intent?
• What are the comparative safety and efficacy considerations between particulate and non-particulate steroids?
• How should anticoagulation and antiplatelet therapy be risk-stratified and managed in the peri-procedural setting?

Your expert panel for this June 11, 2026, webinar included:

• David S. Levi, MD, an interventional spine specialist at the Jordan-Young Institute in Virginia Beach, Virginia, who serves IPSIS as a Standards Division member, Patient Safety Committee Chair, and Bio-Skills Lab Associate Instructor;
• Joshua H. Levin, MD, a Clinical Associate Professor at Stanford University in Los Altos, California, who serves IPSIS as Research Division Vice Chair, Abstract Review Committee Chair, 2026 Annual Meeting Program Committee member, and New Bio-Skills Lab Instructor; and
• Michael Furman, MD, MS, Fellowship Director at OSS Health, who founded and moderates the Ask the Experts series, and serves on the IPSIS Education Division, and as a Bio-Skills Lab Master Instructor.

Watch the “Epidural Steroid Injections — Not As Simple As You'd Think!” webinar where this podcast was recorded. A streaming Ask the Experts video is available here.

Episode 20 Show Notes: These are the abstracts referenced by our experts.

• Beckworth WJ, Ghanbari GM, Lamas-Basulto E, Taylor B. Safety of cervical transforaminal epidural steroid injections. Interv Pain Med. 2024;3(2):100420. doi: https://doi.org/10.1016/j.inpm.2024.100420
• Dawley JD, Moeller-Bertram T, Wallace MS, Patel PM. Intra-arterial injection in the rat brain: Evaluation of steroids used for transforaminal epidurals. Spine (Phila Pa 1976). 2009;34(16):1638-1643. doi: https://doi.org/10.1097/BRS.0b013e3181ac0018
• Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, Bauer Z, Bresnahan BW, Avins AL, Nedeljkovic SS, Nerenz DR, Standaert C, Kessler L, Akuthota V, Annaswamy T, Chen A, Diehn F, Firtch W, Gerges FJ, Gilligan C, Goldberg H, Kennedy DJ, Mandel S, Tyburski M, Sanders W, Sibell D, Smuck M, Wasan A, Won L, Jarvik JG. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371(1):11-21. doi: https://doi.org/10.1056/NEJMoa1313265
• Michael B. Furman, Sean P. Butler, Ruby E. Kim, Ariz R. Mehta, Jeremy I. Simon, Rikin Patel, Thomas S. Lee, Ryan S. Reeves, Injectate Volumes Needed to Reach Specific Landmarks in S1 Transforaminal Epidural Injections, Pain Medicine, Volume 13, Issue 10, October 2012, Pages 1265–1274, https://doi.org/10.1111/j.1526-4637.2012.01474.x
• Furman MB, Mehta AR, Kim RE, Simon JI, Patel R, Lee TS, Reeves RS. Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections. PM R. 2010 Jul;2(7):625-35. doi: 10.1016/j.pmrj.2010.04.023. PMID: 20659718.
• Furman MB, Lee TS, Mehta A, Simon JI, Cano WG. Contrast flow selectivity during transforaminal lumbosacral epidural steroid injections. Pain Physician. 2008 Nov-Dec;11(6):855-61. PMID: 19057631.
• Gharibo CG, Fakhry M, Diwan S, Kaye AD. Conus medullaris infarction after a right L4 transforaminal epidural steroid injection using dexamethasone. Pain Physician. 2016;19(8):E1211-E1214.
• Michael Karasek, Nikolai Bogduk, Temporary Neurologic Deficit After Cervical Transforaminal Injection of Local Anesthetic, Pain Medicine, Volume 5, Issue 2, June 2004, Pages 202–205, https://doi.org/10.1111/j.1526-4637.2004.04028.x
• Moradian M, Tekmyster G, Wei JJ, Avetisian H, Acharya JN, Furman MB, Encephalopathy after unintentional intrathecal gadolinium: A letter to the editor, Interventional Pain Medicine (2022); 1(3): 100105 doi: https://doi.org/10.1016/j.inpm.2022.100105.
• Levi D, Horn S, Murphy J, Smuck M, Levin J. Modification of the cervical transforaminal epidural steroid injection technique based upon the anatomic angle of the superior articular process on MRI. Pain Med. 2020;21(10):2090-2099. doi: https://doi.org/10.1093/pm/pnaa162
• Levi D, Randall D, Horn S, Russo A, Gabri J, Durand M, Levin J. Safety profile of cervical transforaminal epidural steroid injections performed while maintaining anticoagulation, aspirin, or NSAIDs. Interv Pain Med. 2025;4(3):100618. doi: https://doi.org/10.1016/j.inpm.2025.100618
• Maus TP, El-Yahchouchi CA, Geske JR, Carter RE, Kaufmann TJ, Wald JT, Diehn FE. Imaging determinants of clinical effectiveness of lumbar transforaminal epidural steroid injections. Pain Med. 2016;17(12):2176-2184. doi: https://doi.org/10.1093/pm/pnw043
• Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, Guarino AH, Moran CJ, Riew KD. Perils of intravascular methylprednisolone injection into the vertebral artery: An animal study. J Bone Joint Surg Am. 2008;90(9):1932-1938. doi: https://doi.org/10.2106/JBJS.G.01182
• Plastaras CT, Casey E, Goodman BS, Chou L, Roth D, Rittenberg J. Inadvertent intradiscal contrast flow during lumbar transforaminal epidural steroid injections: A case series examining the prevalence of intradiscal injection as well as potential associated factors and adverse events. Pain Med. 2010;11(12):1765-1773. doi: https://doi.org/10.1111/j.1526-4637.2010.00943.x
• Yang C, Kim NE, Beak JS, Tae NY, Eom BH, Kim BG. Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection: A case report. Medicine (Baltimore). 2019;98(50):e18299. doi: https://doi.org/10.1097/MD.0000000000018299

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