Recommendations about the practice of epidural steroid injections for low back pain and sciatica are formulated based on an extensive review of the published literature. These infiltrations should be reserved to trained physicians observing strictly aseptic conditions. Their indications are limited to the few special situations where classical treatments have failed, and only after exclusion of an infectious or tumoral process. To the present time no conclusive data have been published to prove that these procedures reduced the need for surgery in the case of herniated nucleus pulposus or spinal stenosis. Their efficacy on the intensity of pain is also controversial. Some improvement on pain and functional scores may be observed for a few weeks but this positive effect disappears 2 or 3 months post-injection.