Epidural steroid injections (ESIs) play an important role in the multifaceted management of neck and back pain. Corticosteroid preparations used in ESIs may be considered “particulate” or “non-particulate” based on whether they form a crystalline suspension or a soluble clear solution, respectively. In the past two decades, there have been reports of rare but severe and permanent neurological complications as a result of ESI. These complications have principally occurred with particulate corticosteroid preparations when using a transforaminal injection technique at cervical or thoracic levels, and only rarely in the lumbosacral spine. As a result, some published clinical guidelines and recommendations have advised against the use of particulate corticosteroids for transforaminal ESI, and the FDA introduced a warning label for injectable corticosteroids regarding the risk of serious neurological adverse events. There is growing evidence that the efficacy of non-particulate corticosteroids for pain relief and functional improvement after ESI is non-inferior to particulate agents, and that non-particulate injections almost never result in permanent neurological injury. Despite this, particulate corticosteroids continue to be routinely used for transforaminal epidural injections. More consistent clinical guidelines and societal recommendations are required alongside increased awareness of the comparative efficacy of non-particulate agents among specialists who perform ESIs. The current role for particulate corticosteroids in ESIs should be limited to caudal and interlaminar approaches, or transforaminal injections in the lumbar spine only if initial non-particulate ESI resulted in a significant but short-lived improvement.

硬膜外类固醇注射 (ESI) 在颈部和背部疼痛的多方面治疗中发挥着重要作用。ESI 中使用的皮质类固醇制剂可分别根据它们是否形成结晶悬浮液或可溶性澄清溶液而被视为“颗粒”或“非颗粒”。在过去的二十年中，已有报道称 ESI 导致罕见但严重且永久性的神经系统并发症。这些并发症主要发生在颈椎或胸椎使用经椎间孔注射技术时，微粒皮质类固醇制剂，很少发生在腰骶椎。因此，一些已发表的临床指南和建议建议不要使用颗粒皮质类固醇进行经椎间孔 ESI，并且 FDA 为注射皮质类固醇引入了关于严重神经不良事件风险的警告标签。越来越多的证据表明，非颗粒皮质类固醇在 ESI 后缓解疼痛和功能改善的功效并不逊色于颗粒药物，而且非颗粒注射几乎不会导致永久性神经损伤。尽管如此，颗粒皮质类固醇仍然常规用于经椎间孔硬膜外注射。需要更一致的临床指南和社会建议，同时提高执行 ESI 的专家对非颗粒制剂比较功效的认识。目前颗粒皮质类固醇在 ESI 中的作用应仅限于尾部和椎板间入路，或仅在初始非颗粒 ESI 导致显着但短暂的改善时才在腰椎经椎间孔注射。