Multisociety Practice Parameter Updates Standards for Image-Guided Epidural Steroid Injections

Updated ACR/SIR multisociety guideline mandates image guidance for all epidural steroid injections (ESI), citing rare but serious FDA-flagged neurologic risks. ESI recommended within multidisciplinary care, not as stand-alone therapy, for neck/low back pain with radiculopathy.

• Guideline jointly revised by ACR, SIR, SNIS, ASNR, and ASSR; covers indications, contraindications, patient selection, and technical execution for ESI in spinal pain and radiculopathy refractory to conservative therapy.
• Key new emphasis: ESI must be performed with image guidance, meticulous technique, and detailed spinal anatomy knowledge; absolute and relative contraindications are explicitly specified.
• Limitation: Recommendations are consensus/evidence-based but specific evidence grades or levels are not reported in the source snippet; generalizability depends on institutional credentialing and multidisciplinary infrastructure.

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