The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.