Systematic review of therapeutic lumbar transforaminal epidural steroid injections (original) (raw)
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Pain physician
Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. The available literature ...
Transforaminal Lumbar Epidural Steroid Injections
October 2000, 2000
Low back pain is an important medical, social, and economic problem involving approximately 15% to 39% of the population. Of the numerous therapeutic interventions available for treatment of chronic low back pain, including surgery, epidural administration of corticosteroids is one such intervention commonly used. Several approaches available to access the lumbar epidural space are the caudal, interlaminar, and transforaminal, also known as nerve root or selective epidural injection. The objective of an epidural steroid injection is to deliver corticosteroid close to the site of pathology, presumably onto an inflamed nerve root. This objective can be achieved by the transforaminal route rather than the caudal or interlaminar routes. Reports of the effectiveness of epidural corticosteroids have varied from 18% to 90%. However, reports of the effectiveness of transforaminal epidural steroids have shown it to be superior, with outcome data indicating cost effectiveness as well as safety. This review describes various aspects of transforaminal epidural steroid injections in managing chronic low back pain.
Transforaminal Epidural Steroid Injection – A Promising Insight in Pain Intervention
SOJ Anesthesiology & Pain Management
Background: Back pain of lumbar origin known as "Lumbosacral Radiculopathy" is a debilitating ailment in today's modern world. The treatment modalities have been many over years ranging from prolonged bed rest, the use of analgesic medications to surgical decompression. Objective: In our study we have used a minimally invasive technique called the Transforaminal Epidural Steroid Injection using the steroid Triamcinolone under Fluoroscopic guidance in 30 patients of low back pain, lumbar in origin in order to alleviate pain, bridging the gap between conservative management and invasive surgical decompression with high morbidity rates.
Pain, 1995
The purpose of the study was to assess the efficacy of epidural steroid injections for low-back pain. Data was obtained using computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Twelve randomized clinical trials evaluating epidural steroid injections were identified. Data was extracted based on scores for quality of the methods, using 4 categories (study population, interventions, effect measurement, and data presentation and analysis) and the conclusion of the author(s) with regard to the efficacy of epidural steroid injections. Method scores of the trials ranged from 17 to 72 points (maximum 100 points). Eight trials showed method scores of 50 points or more. Of the 4 best studies (> 60 points), 2 reported positive outcomes and 2 reported negative results. Overall, 6 studies indicated that the epidural steroid injection was more effective than the reference treatment and 6 reported it to be no better or worse than the reference treatment. There appeared to be no relationship between the methodological quality of the trials and the reported outcomes. In conclusion, there are flaws in the design of most studies. The best studies showed inconsistent results of epidural steroid injections. The efficacy of epidural steroid injections has not yet been established. The benefits of epidural steroid injections, if any, seem to be of short duration only. Future research efforts are warranted, but more attention should be paid to the methods of the trials.
Our experience with epidural steroid injections in the management of low back pain and sciatica
The Internet Journal of Orthopedic Surgery, 2012
Background: Low back pain (LBP) and sciatica is a common clinical condition worldwide.The initial treatment of Low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a reliable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of ongoing study of the use of epidural steroid injection the management of low back pain cases coming to the orthopaedic department of Government Medical College Jammu. Methods: 150 Patients reporting with low back pain and sciatica not responding to other modes of conservative treatment were prospectively followed over a two year period. The caudal epidural steroid injections were performed, as many as three injections two week apart .The patients were assessed before and after the procedure clinically and the Level of pain, improvement in physical signs and ability to do activities of daily living were noted. Results:150 patients were observed for the duration of 2 years. Average duration of symptoms was for six months. After first epidural steroid injection 80% [120] of patients reported relief within first two weeks. Forty Four (44) patients required two injections and 12 patients required three injections. Twelve (12) patients reported no relief after first injection. The duration between two injections was two to three weeks. Average duration of pain relief was 17days. At the end of three months, good results were seen in 49%, fair in 32% and bad results in 18%. Overall 69% of patients were able to do activities of daily living. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. Conclusion: Epidural Steroid Injection is a simple, cost effective and minimally invasivemode of treatment of Low Back Pain and sciatica. It provides pain free period to enable the patient for physiotherapy which helps in early recovery.
Annals of International medical and Dental Research, 2017
It is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. radiculopathy secondary to disc herniation resolves spontaneously in 23% to 48% of patients, 5% to 15% of patients undergo surgery, resulting in a strain on the health care system and subsequently, the economy. [6-9] Various conservative, nonsurgical modalities for treating lumbar disc herniation or radicular pain exist, including epidural injections. Data from the Spine Patient Outcomes Research Trial (SPORT) evaluation reported the clinical and cost effectiveness of lumbar disc herniation ABSTRACT Background: Transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) are commonly performed procedures for the management of unilateral lumbosacral radicular pain (LSRP) due to intervertebral disc herniations. Unilateral LSRP is thought to originate from inflammation in the proximity of a damaged intervertebral disc or a narrowed neuralforamen that irritates an exiting spinal nerve root. Thus corticosteroids are commonly used to reduce inflammation in the epidural space. The purported advantage of TFESI over ILESI is attributed to enhanced deposition of medication in closest proximity to the pain generators found in the ventral epidural space and hence reaching the targeted pain generators with a smaller dose of medication. Data from multiple studies and systematic reviews of the published data support the utility of TFESI and have shown that lumbar TFESI are effective for reducing pain, improving functionality, preventing spine surgery and for treating radiculopathic pain. Methods: In a prospective study, 60 patients with low back pain were randomly allocated to one of the two groups of 30 patients each. In Group IL(interlaminar approach), with the patient in lateral position, under strict aseptic precautions, 18G Tuohy needle is placed by loss of resistance technique and confirmed using iohexol dye and 80 mg (2 mL) of methyprednisolone with 2 mL of normal saline is injected. In group TF(transforaminal approach), with the patient in prone position, under strict aseptic precautions, 23 G Quinke needle is placed in epidural space under C-arm guidance and confirmed by using Iohexol dye and 80 mg (2 mL) of methyprednisolone with 2 mL of normal saline is injected. Patient monitored for 15 mins after the procedure. Pain relief assessed by using Numerical Rating Scale(NRS), Verbal Rating Scale(VRS), Straight Leg Raising Test(SLRT) etc. Results: In Group IL, NRS decreased from 7.77±1.2 (pre-procedure) to 4.73±1.1 and 4.27±1.5 at the end of 2nd and 3rd week respectively. In Group TF, NRS decreased from 7.8±1.3 (pre-procedure) to 2.77±1.7 and 2.63±1.7 at the end of 2nd and 3rd week respectively. This difference in NRS was statistically significant both at the end of 2nd week and 3rd week with a P value of 0.001 with Group TF having better pain relief. There was no statistically significant difference among the 2 groups with respect to SLRT, improvement in walking tolerance, reduction in analgesic use and reversal of paraesthesia at the end of 3rd week. Conclusion: Epidural steroid injection by transforaminal route provides better subjective pain relief in the short term.
Anesthesiology and Pain Medicine, 2015
Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0-10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67-90.5%) of patients in PIL group and 74.2% (95% CI: 62.4-89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration.
Pain physician, 2014
BACKGROUND Epidural injections are the most common minimally invasive intervention used to manage low back pain with lumbosacral radicular pain. It can be delivered through either transforaminal (TF), interlaminar, or caudal approaches. The TF approach is considered more efficacious than the interlaminar approach probably because of ventral epidural spread. However, catastrophic complications reported with the TF approach have raised concerns regarding its use. These concerns regarding the safety of the TF approach lead to the search for a technically better route with lesser complications with drug delivery into the ventral epidural space. The parasagittal interlaminar (PIL) route is reported to have good ventral epidural spread. However, there is a paucity of literature comparing the effectiveness of PIL with TF. OBJECTIVES To compare effectiveness of PIL and TF epidural injections for managing low back pain with lumbosacral radicular pain. STUDY DESIGN Randomized, double-blind, a...
Frontiers in Pain Research
Background: Epidural steroid injection (ESI) has proven benefits in controlling chronic low back pain and can be performed via the midline interlaminar (MIL) or transforaminal (TF) approach. A modified interlaminar approach, the parasagittal interlaminar (PIL), has surfaced as a more reliable, safe, and suitable approach to minimize complications related to MIL and TF.Objective: To conduct a systematic review and meta-analysis to assess and compare the effectiveness and safety of PIL with both MIL and TF approaches in adult patients with a history of chronic low back pain.Methods: A literature search was conducted using major electronic databases, such as PubMed, EMBASE, and Cochrane. Selected studies included patients with unilateral radicular symptoms, secondary to lumbar intervertebral disc hernias or degenerative lumbar disc disease, that, additionally, received ESIs via PIL or either MIL or TF under fluoroscopic guidance. Randomized and observational studies with pain relief sc...