[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-451086-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-451086-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","time-to-standardize-the-german-spine-society-national-clinical-guideline-on-epidural-injections","Time to standardize - The German Spine Society national clinical guideline on epidural injections","","Guideline text addresses cervical and lumbar pain originating in the spine and the frequent use of epidural injections for radicular pain, including cases involving axial pain. It emphasizes the need for consistent terminology, because historical practice in Germany often uses injections without imaging and results in heterogeneous techniques, medications, and indications. The German Spine Society guideline evaluates injection techniques and anatomy with imaging considerations and structured risk-benefit recommendations, using GRADE evidence appraisal and AGREE II methodological review.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/time-to-standardize-the-german-spine-society-national-clinical-guideline-on-epidural-injections/451086/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/time-to-standardize-the-german-spine-society-national-clinical-guideline-on-epidural-injections/451086.png","ImageObject",300,407,{"name":42,"@type":43},"Chumphorn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How does the guideline define epidural injections and access routes?","Question",{"text":63,"@type":64},"It distinguishes three access routes to the epidural space: transforaminal, interlaminar, and caudal, each differentiated by indication, efficacy, risks, and implementation.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What does PRT mean in this guideline?",{"text":68,"@type":64},"PRT (periradicular therapy) refers to an image-guided transforaminal injection into the epidural space at a defined nerve root.",{"name":70,"@type":61,"acceptedAnswer":71},"What evidence-based guidance is given for diagnostic transforaminal injections?",{"text":72,"@type":64},"A diagnostic transforaminal injection may identify a painful nerve root, and it should be performed with a small amount of local anesthetic (0.2–0.3 ml).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},451086,1791188234,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & 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Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":111,"preview_page_count":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","Interventional Pain Medicine 5 (2026) 100720  \nContents lists available at ScienceDirect  \nInterventional Pain Medicine  \njournal [homepage:](homepage: www.journals.elsevier.com/interventional-pain-medicine)[ www.journals.elsevier.com/interventional-pain-medicine](homepage: www.journals.elsevier.com/interventional-pain-medicine)  \nTime to standardize: The German Spine Society national clinical guideline on epidural injections    \nPain originating in the cervical or lumbar spine remains a major clinical and socioeconomic burden. It is important to distinguish between axial pain and radicular pain, the latter arising from a nerve root and radiating toward the arm or leg, presenting as neuropathic pain. Epidural injections targeting the ventral and dorsal nerve roots are very frequently performed interventions for disc herniations and lumbar sciatica. Therefore, epidural injections are often used for radicular pain but also sometimes for axial pain. Typically, anti-inflammatory and analgesic medications are used.  \nIn Germany, there is a historical practice of administering spinal injections without imaging, which continues to be taught. Numerous anatomical structures can be targeted in this manner, including the joint space of a facet joint, the joint capsule, the spinal nerve, a nerve root, orthe epidural space. However, uniform terminology for these procedures is lacking; broad and imprecise terms such as “spinal” or “paravertebral”injections are common, and the abbreviation “PRT” (“periradicular therapy”) is often used indiscriminately. Procedures using imaging and considerations of the evidence for individual injection methods are only very slowly being accepted, resulting in substantial heterogeneity in techniques, medications, and indications. Therefore, the German Spine Society (Deutsche Wirbels¨aulengesellschaft, DWG) commissioned a guideline on epidural injections, which was published via the Association of the Scientific Medical Societies of Germany (AWMF) [1].  \nTo evaluate effectiveness and formulate clear recommendations, the guideline systematically examined different injection techniques and anatomical regions, separately addressing cervical and lumbar procedures and transforaminal, interlaminar, and caudal approaches. The role of imaging guidance was also assessed. The overall goal was a structured risk–benefit evaluation that supports clinical decision-making regarding access routes, indications, technical implementation, pharmacologic agents, and potential risks.  \nThe guideline was published by the AWMF on June 27, 2025. It comprises a long version, a short version, a patient-oriented summary, a detailed methodological report, and comprehensive evidence tables (including GRADE assessments). All materials are freely accessible at [https://register.awmf.org/de/leitlinien/detail/151-005](https://register.awmf.org/de/leitlinien/detail/151-005).  \nEvidence appraisal followed a structured literature review using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology [2]. Evidence quality was categorized as high, moderate, low, or very low, reflecting the confidence that observed effect sizes represent true effects [3]. The completed guideline was further evaluated using the AGREE II instrument to ensure methodological rigor and transparency [4].  \nA multidisciplinary workgroup comprising anesthesiologists, neurologists, neuroradiologists, neurosurgeons, orthopedic and trauma  \nsurgeons, radiologists, physiotherapists, and patient representatives participated in all stages of the process. Together, they formulated 14 clinical PICO questions, selected and evaluated the literature, and drafted recommendations [5]. Recommendation strength followed three levels (A: strong; B: weak; 0: open), with expert consensus (EC) applied where evidence was lacking.  \nConsensus was achieved through a modified Delphi process and finalized during a conference moderated by the AWMF. Internal and exter","cbCailHHao8HWDpS","https://ap.wps.com/l/cbCailHHao8HWDpS","pdf",376595,"English","# Definitions and access routes\n## Epidural space access routes\n## Periradicular therapy (PRT)\n## Contrast/medication distribution targets\n# Diagnostic transforaminal epidural injections\n## Identification of painful nerve root\n## Small-volume local anesthetic approach\n# Therapeutic transforaminal epidural injections\n## Cervical spine radicular complaints\n## Imaging-assisted recommendations","[{\"question\":\"How does the guideline define epidural injections and access routes?\",\"answer\":\"It distinguishes three access routes to the epidural space: transforaminal, interlaminar, and caudal, each differentiated by indication, efficacy, risks, and implementation.\"},{\"question\":\"What does PRT mean in this guideline?\",\"answer\":\"PRT (periradicular therapy) refers to an image-guided transforaminal injection into the epidural space at a defined nerve root.\"},{\"question\":\"What evidence-based guidance is given for diagnostic transforaminal injections?\",\"answer\":\"A diagnostic transforaminal injection may identify a painful nerve root, and it should be performed with a small amount of local anesthetic (0.2–0.3 ml).\"}]","Time to standardize - The German Spine Society national clinical guideline on epidural injections | PDF",1790734343]