{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:52:29Z","timestamp":1777330349801,"version":"3.51.4"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rofo"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Epidural injections are frequently performed for radicular pain. The German Society for Spine Surgery (DWG) published an S3 guideline for assessing benefits and performing epidural injections. The goal is to standardize the indication, technique, and medication selection based on evidence.<\/jats:p>\n                  <jats:p>The guideline was developed with the participation of ten professional associations and a patient representative using the AGREE II tool. It was based on a systematic literature review with GRADE assessment. Fourteen PICO questions were addressed.<\/jats:p>\n                  <jats:p>The evidence varies greatly depending on the approach and region. Transforaminal injections are recommended for radicular pain. Interlaminar injections have been shown to have a short-term effect for radicular pain in the lumbar spine. All randomized benefit assessment studies used fluoroscopy for transforaminal injections. CT or ultrasound scanning is also possible. Particulate steroids and preparations containing potentially neurotoxic preservatives should be avoided due to the potential for serious complications. Neurological follow-up and patient feedback are important. Repeat injections are only indicated if there has been a prior response. Series of injections without assessing the efficacy should not be performed.<\/jats:p>\n                  <jats:p>The new S3 guideline provides practical, evidence-based recommendations for the safe performance of epidural injections. It offers important guidance on indication, technique, and drug selection. Individual medical assessment remains essential.<\/jats:p>","DOI":"10.1055\/a-2702-4560","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T22:57:03Z","timestamp":1759186623000},"page":"604-609","source":"Crossref","is-referenced-by-count":0,"title":["The New S3 Guideline on \u201cEpidural injections\u201d"],"prefix":"10.1055","volume":"198","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1180-9908","authenticated-orcid":false,"given":"Stephan","family":"Klessinger","sequence":"additional","affiliation":[{"name":"Neurosurgery, Neurosurgery Biberach, Biberach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref1","first-page":"E539","article-title":"Epidural Injections for Lumbar Radiculopathy or Sciatica: A Comparative Systematic Review and Meta-Analysis of Cochrane Review","volume":"24","author":"L Manchikanti","year":"2021","journal-title":"Pain Physician"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2657-9236","article-title":"Radiologische Schmerztherapien an der Wirbels\u00e4ule \u2013 Retrospektive Auswertung der DeGIR-Registerdaten 2021","author":"R Fessl","year":"2025","journal-title":"Rofo"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"GH Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E839","DOI":"10.1503\/cmaj.090449","article-title":"AGREE II: advancing guideline development, reporting and evaluation in health care","volume":"182","author":"MC Brouwers","year":"2010","journal-title":"CMAJ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jclinepi.2010.09.012","article-title":"GRADE guidelines: 2. Framing the question and deciding on important outcomes","volume":"64","author":"GH Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.spinee.2011.04.004","article-title":"Comparison of clinical effectiveness of cervical transforaminal steroid injection according to different radiological guidances (C-arm fluoroscopy vs. computed tomography fluoroscopy)","volume":"11","author":"JH Lee","year":"2011","journal-title":"The Spine Journal"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.rcl.2023.09.006","article-title":"The Anatomy, Technique, Safety, and Efficacy of Image-Guided Epidural Access","volume":"62","author":"T Maus","year":"2024","journal-title":"Radiologic Clinics of North America"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/j.1526-4637.2007.00341.x","article-title":"Size and Aggregation of Corticosteroids Used for Epidural Injections","volume":"9","author":"R Derby","year":"2008","journal-title":"Pain Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1007\/s00256-022-04273-5","article-title":"Intra-arterial injection of particulate corticosteroids: mechanism of injury","volume":"52","author":"J-D Laredo","year":"2023","journal-title":"Skeletal Radiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.1097\/BRS.0b013e3181ac0018","article-title":"Intra-Arterial Injection in the Rat Brain: Evaluation of Steroids Used for Transforaminal Epidurals","volume":"34","author":"JD Dawley","year":"2009","journal-title":"Spine"},{"key":"ref12","first-page":"1932","article-title":"Perils of Intravascular Methylprednisolone Injection into the Vertebral Artery: An Animal Study","volume":"90","author":"GO Okubadejo","year":"2008","journal-title":"The Journal of Bone and Joint Surgery-American Volume"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1136\/rapm-2020-101778","article-title":"Risk of serious spinal adverse events associated with epidural corticosteroid injections in the Medicare population","volume":"46","author":"E Eworuke","year":"2021","journal-title":"Reg Anesth Pain Med"}],"container-title":["R\u00f6Fo - Fortschritte auf dem Gebiet der R\u00f6ntgenstrahlen und der bildgebenden Verfahren"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2702-4560.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:30:50Z","timestamp":1777329050000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2702-4560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":12,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,4,27]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2702-4560","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1438-9029","1438-9010"],"issn-type":[{"value":"1438-9029","type":"print"},{"value":"1438-9010","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}