scholarly journals Particulate vs Non-Particulate Steroids for Transforaminal Epidural Steroid Injections: Systematic Review and Meta-analysis of the Current Literature

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. 327-340 ◽  
Author(s):  
Jeetinder Kaur Makkar
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Visual Analogue Score ◽  
Cochrane Collaboration ◽  
Radicular Pain ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Open Access Journals ◽  
Epidural Steroid ◽  
Epidural Steroids

Background: The efficacy of particulate and non-particulate steroids in patients receiving epidural steroid injections remains unclear. Objective: The purpose of this meta-analysis was to compare the efficacy of particulate and non-particulate steroids in patients receiving epidural injections for radicular pain over 3 months. Study Design: Systematic review and meta-analysis. Methods: We reviewed PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar, and Directory of open access journals for trials that compared efficacy of particulate steroid with non-particulate. A meta-analysis was performed on treatment related to mean change in visual analogue score (VAS) between the particulate and non-particulate steroids. Two authors independently reviewed the data for inclusion. Results: Seven studies comprising 3,542 patients in the particulate group and 856 patients in the non-particulate group were included. Pooled mean maximum change of VAS was higher by 0.53 (95% CI: 0.14 to 0.92; P = 0.007; I2 = 50.2%) in the particulate group compared to the non-particulate group. The non-particulate group had a larger proportion of patients with more than 50% pain relief than the particulate group [OR 0.81 (95% CI: 0.68 to 0.97, P = 0.024). Limitations: Limited number of trials that fit the inclusion criteria and were available for analysis. Conclusions: As the use of particulate steroids seems to be associated with slightly better VAS scores only, clinicians need to weigh their clinical relevance in the light of complications and recent FDA recommendations on the use of particulate steroids. Key words: Meta-analysis, particulate epidural steroids, non-partiuclate epidural steroids, efficacy, decrease in pain scores

scholarly journals Transforaminal Versus Interlaminar Approaches to Epidural Steroid Injections: A Systematic Review of Comparative Studies for Lumbosacral Radicular Pain

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E509-E524
Author(s):  
Kenneth D. Candido
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Radicular Pain ◽  
Functional Improvement ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Clinically Significant ◽  
Epidural Steroid ◽  
Significant Superiority

Background: The superiority of transforaminal epidural steroid injections (TFESI) vs. interlaminar epidural steroid injections (ILESI) for treating unilateral lumbosacral radicular pain (LSRP) is unproven. Objective: To assess studies comparing TFESI to ILESI for unilateral LSRP for pain relief and functional improvement. Study Design: Systematic review of comparative studies. Methods: A systematic literature search was conducted using the Cochrane Central Register of Controlled Trials, PubMed, and Scopus databases for trials reported in English. Studies meeting the Cochrane Review criteria for randomized trials and the AHCQ criteria for observational studies were included. Evidence was graded using the USPSTF classification. Results: Five (prospective) and 3 (retrospective) studies were included assessing 506 patients. Statistical analysis was calculated only utilizing the 5 prospective studies and consisted of 249 patients with an average of 3.2 months follow-up. In the short-term (2 weeks), there was a 15% difference favoring TFESI vs. ILESI for pain relief. There was no efficacy difference at one or 6 months. Combined pain improvements in all 5 prospective studies revealed < 20% difference between TFESI and ILESI (54.1% vs. 42.7%). There was slightly better functional improvement in ILESI groups (56.4%) vs. TFESI groups (49.4%) at 2 weeks. Combined data showed slight differences (TFESI 40.1% and ILESI 44.8%). Limitations: The limitations of this systematic review include the relative paucity of comparative studies. Conclusions: The findings show that both TFESI and ILESI are effective in reducing pain and improving functional scores in unilateral LSRP. In the treatment of pain, TFESI demonstrated non-clinically significant superiority to ILESI only at the 2-week follow-up. Based on 2 studies, ILESI demonstrated non-clinically significant superiority to TFESI in functional improvement. Key words: Radiculopathy, epidural steroids, transforaminal, interlaminar, systematic review

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

scholarly journals The Effectiveness of Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection for the Treatment of Radicular Pain; a Systematic Review and Meta-analysis

Pain Medicine ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Aaron Conger ◽  
Daniel M Cushman ◽  
Rebecca A Speckman ◽  
Taylor Burnham ◽  
Masaru Teramoto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparison Group ◽  
Steroid Injection ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Response Rates ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Objective Determine the effectiveness of fluoroscopically guided cervical transforaminal epidural steroid injection (CTFESI) for the treatment of radicular pain. Design Systematic review and meta-analysis. Subjects Persons aged ≥18 years with cervical radicular pain due to disc herniation or degenerative spondylosis. Comparison Sham, placebo procedure, or active standard of care treatment, excluding alternative versions of epidural steroid injection. Outcomes The primary outcome measure was patient-reported improvement in pain of at least 50% from baseline, assessed four or more weeks after the treatment intervention. Secondary outcomes included validated functional assessment tools and avoidance of spinal surgery. Methods Randomized or nonrandomized comparative studies and nonrandomized studies without internal control were included. Three reviewers independently assessed publications in the Medline, PubMed, and Cochrane databases up to July 2018. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to evaluate risk of bias and overall quality of evidence. A meta-analysis was conducted for comparative measures of effect and for within-group response rates if applicable. Results There were no studies with an internal comparison group (control group) meeting the review’s definition of comparison group. Therefore, comparative measures of effect were not calculated. In cohort studies, pooled response rates were 48% (95% confidence interval [CI] = 34–61%) at one month and 55% (95% CI = 45–64%) at three months. Conclusions Approximately 50% of patients experience ≥50% pain reduction at short- and intermediate-term follow-up after CTFESI. However, the literature is very low quality according the GRADE criteria, primarily due to a lack of studies with placebo/sham or active standard of care control comparison groups.

Efficacy of Lumbosacral Transforaminal Epidural Steroid Injections: A Systematic Review

PM&R ◽  
2009 ◽  
Vol 1 (7) ◽  
pp. 657-668 ◽  
Author(s):  
Scott T. Roberts ◽  
Stuart E. Willick ◽  
Monica E. Rho ◽  
Joshua D. Rittenberg
Keyword(s):  
Systematic Review ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid
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