26 randomized controlled trials were included in this systematic review and meta-analysis to determine if epidural steroid injections (ESI) have surgery-sparing effect in patients with low back pain. The results of this study varied. One trial that evaluated secondary surgery as a primary outcome indicated that ESI reduced the need for surgery. However, pooled results from a number of studies at both short- (<1 year, 5 studies) and mid-term (>1 year, 16 studies) follow-up provided moderate quality evidence that there are no significant differences in the rate of secondary surgery between ESI and control groups. A non-significant trend towards a decreased need for surgery among patients who had received ESI was observed in the short-term analysis.