“Standard of care” can vary along regional and specialty lines; it is common to discover that a local “standard” can be different somewhere else. Opinions may differ between pain management specialists, primary care physicians, and spine surgeons with regard to use of conservative treatment modalities.

Opinion within a given group of practitioners, however, should converge. Local differences between hospitals may exist, but conferences, professional journals, and national boards for certification are mechanisms that should act to maintain homogeneity within a professional group. It could be expected that commonly utilized treatment approaches within a well defined group of sub-specialists should converge.

One of the more common non-surgical options for herniated lumbar spinal discs is epidural steroid injections (ESIs). Patients may be referred to pain management centers for lumbar ESIs by their primary care physician or perhaps after consultation with a surgical specialist. We sought to assess the opinion of practicing spine surgeons with regard to timing and use of lumbar ESIs as a part of a conservative treatment approach to both lumbar disk herniations (HNP) and lumbar degenerative disk disease (DDD).

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