Background: Epidural steroid injections are indicated for radicular pain, with a pre-injection MRI not mandated in guidelines. There is conflicting evidence that MRI findings correlate with outcomes.

Methods: Fourteen patients with near-normal imaging (i.e., no evidence of nerve root compression and minor degenerative changes if present) who underwent ESI for lumbosacral radicular pain and were followed for up to 12 weeks were propensity matched against 14 patients with radicular pain secondary to concordant MRI pathology. The primary outcome measure was mean reduction in average leg pain relief at 4 and 12 weeks. Secondary outcome measures included average back pain, function, analgesic reduction, satisfaction, and a categorical measure of success predesignated as a ≥2-point decrease in average leg pain score coupled with a positive global perceived effect and not requiring any additional intervening interventions.

Results: For mean reduction in average leg pain at 4 weeks, there were no significant differences between those with near-normal MRIs and those with abnormal imaging (2.36 (SD 2.55) vs. 2.61 (SD 2.15); P = 0.72). For average back pain reduction at the same time point, the mean reduction was 0.75 (1.73) among cases vs. 1.07 (2.01) in control patients (P = 0.57). There were also no differences observed in pain reduction outcomes at 12 weeks. The average reduction in Oswestry Disability Index at 12 weeks favored the near-normal imaging group (8.64 % (SD 11.36) vs. 0 % (7.69); P = 0.047). A trend was noted wherein more patients with abnormal imaging experienced a positive outcome at 4 weeks (50 % vs. 28.57 %; P = 0.22) but not 12 weeks (28.57 % in both groups).

Conclusions: There were no significant differences in pain outcomes compared to control patients, though patients with near-normal imaging fared worse than historical controls and the larger cohort from which propensity-matched patients were selected. The possibility of poorer outcomes should be considered when selecting patients with normal imaging and radiculopathy for ESI.

Keywords: Epidural steroid injection; MRI; Normal.

© 2025 Published by Elsevier Inc. on behalf of International Pain & Spine Intervention Society.

背景： 硬膜外类固醇注射用于治疗根性疼痛，指南中并未强制要求进行注射前的MRI检查。现有证据表明，MRI结果与预后之间的相关性存在争议。

方法： 本研究对14名影像学接近正常的患者（即没有神经根受压的迹象和如果存在的话只有轻微退行性改变）进行硬膜外类固醇注射治疗腰骶部根性疼痛，并随访长达12周。这些患者的倾向匹配与另外14名因相同MRI病理性变化导致根性疼痛的患者进行了比较。主要结局指标是在4周和12周期间平均腿痛减轻量的均值。次要结局指标包括平均背痛、功能改善、镇痛药使用减少、满意度以及预设为平均腿痛评分降低≥2分且整体感知效果为阳性并且不需要任何额外干预措施的成功分类评价。

结果： 在4周时，对于平均腿痛减轻量的均值，影像学接近正常组和异常影像组之间无显著差异（分别为2.36 (SD 2.55) 和 2.61 (SD 2.15)，P = 0.72）。在同一时间点上，背痛平均减轻程度在病例组为0.75 (1.73)，对照患者中为1.07 (2.01)（P = 0.57）。同样，在12周时未观察到疼痛缓解结果的差异。然而，在12周时，Oswestry功能障碍指数平均降低在影像学接近正常组比异常影像组更有优势（分别为8.64% (SD 11.36) 和0% (7.69)，P = 0.047）。值得注意的是，在4周时，更多异常影像患者表现出积极结果（50% 对28.57%，P = 0.22），但在12周时两组间无明显差异（均为28.57%）。

结论： 与对照患者相比，疼痛预后方面没有显著差异。然而，影像学接近正常的根性病变患者比历史对照和选择倾向匹配患者的更大队列中表现得更差。在为具有正常影像的根性病患者选择硬膜外类固醇注射治疗时，应考虑存在较差的结果的可能性。

关键词： 硬膜外皮质激素注射；MRI；正常。