Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review

Andreisek, Gustav; Jenni, Maja; Klingler, Dominic; Wertli, Maria M.; Elliott, Marina; Ulbrich, Erika J.; Winklhofer, Sebastian; Steurer, Johann

doi:10.1007/s00256-013-1713-5

Cited by 15 publications

(7 citation statements)

References 94 publications

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“…11 Extensive spinal fusion and/or scoliosis make translaminar LP a high-risk and complicated route of access to thecal space and there have been reports of patients who refused to have additional injections due to the difficulty of the procedure. 13,14 In these patients, transforaminal LP is an alternative route for the administration of nusinersen intrathecally.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Intrathecal Access for Injection of Nusinersen in Adult and Pediatric Patients with Spinal Muscular Atrophy

Shokuhfar

Abdalla

Hurley

et al. 2019

Journal of Pediatric Neurology

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The main purpose of this article is to assess the safety and efficacy of transforaminal lumbar puncture for the injection of nusinersen (Spinraza) in patients with extensive spinal fusion and/or scoliosis.A retrospective chart reviews of all spinal muscular atrophy patients (adults and children) were conducted. Demographic data, procedure details, follow-ups, and related complications were recorded.We performed 85 transforaminal injections in nine pediatric patients (5 male and 4 female) aged between 8 and 17 years (mean = 11 years) and seven adult patients (5 females and 2 males) aged between 24 and 41 years (mean= 30 years). Fluoroscopy guidance was used in 87% of our patients. No major complication was reported.Fluoroscopy-guided transforaminal nusinersen injection is a safe and successful alternative approach in adult and pediatric patients with severe spinal scoliosis, interlaminar osseous fusion, and spinal fusion hardware.

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Section: Discussionmentioning

confidence: 99%

Transforaminal Intrathecal Access for Injection of Nusinersen in Adult and Pediatric Patients with Spinal Muscular Atrophy

Shokuhfar

Abdalla

Hurley

et al. 2019

Journal of Pediatric Neurology

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“…Most clinicians believe that TF-ESI exhibits superior efficacy and is being performed with increasing frequency, although this belief seems to be unsubstantiated. 23 , 38 , 39 , 55 Our study has demonstrated that TF-ESI and C-ESI are similarly effective in managing lumbosacral radicular pain. Before selecting a steroid injection route for the management of radicular pain, the benefits and risks of the approaches discussed herein must be taken into consideration, as the outcomes of this review were not significantly different between the 2 treatment groups.…”

Section: Discussionmentioning

confidence: 74%

The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain

Liu

Zhou

et al. 2016

Medicine

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Epidural steroid injection (ESI) is one of the most commonly used treatments for radiculopathy. Previous studies have described the effectiveness of ESI in the management of radiculopathy. However, controversy exists regarding the route that is most beneficial and effective with respect to the administration of epidural steroids, as both transforaminal (TF) and caudal (C) routes are commonly used.This analysis reviewed studies comparing the effectiveness of TF-ESIs with that of C-ESIs in the treatment of radiculopathy as a means of providing pain relief and improving functionality. This meta-analysis was performed to guide clinical decision-making.The study was a systematic review of comparative studies.A systematic literature search was performed using the PubMed, EMBASE, and Cochrane Library databases for trials written in English. The randomized trials and observational studies that met our inclusion criteria were subsequently included. Two reviewers, respectively, extracted data and estimated the risk of bias. All statistical analyses were performed using Review Manager 5.3.Six prospective and 2 retrospective studies involving 664 patients were included. Statistical analysis was performed utilizing only the 6 prospective studies. Although slight pain and functional improvements were noted in the TF-ESI groups compared with the C-ESI groups, these improvements were neither clinically nor statistically significant.The limitations of this meta-analysis resulted primarily from the weaknesses of the comparative studies and the relative paucity of patients included in each study.Both the TF and C approaches are effective in reducing pain and improving functional scores, and they demonstrated similar efficacies in the management of lumbosacral radicular pain.

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“…Our interventional approach also fits into the current trend toward increased use of transforaminal access routes in periradicular infiltration therapy or ESI [24]. Therefore, the protocol presented here should be of interest to most interventional radiologists.…”

Section: Discussionmentioning

confidence: 90%

Periradicular Infiltration of the Cervical Spine: How New CT Scanner Techniques and Protocol Modifications Contribute to the Achievement of Low-Dose Interventions

Elsholtz

Kamp

Vahldiek

et al. 2018

Fortschr Röntgenstr

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Access routes and reported decision criteria for lumbar epidural drug injections: a systematic literature review

Abstract: The most commonly used access routes for epidural drug injection are the interlaminar and transforaminal pathways at the level of the pathology. Transforaminal routes are being performed with increasing frequency in recent years.

Cited by 15 publications

References 94 publications

Transforaminal Intrathecal Access for Injection of Nusinersen in Adult and Pediatric Patients with Spinal Muscular Atrophy

Transforaminal Intrathecal Access for Injection of Nusinersen in Adult and Pediatric Patients with Spinal Muscular Atrophy

The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain

Periradicular Infiltration of the Cervical Spine: How New CT Scanner Techniques and Protocol Modifications Contribute to the Achievement of Low-Dose Interventions

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