Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes

Pandey, Ritesh Arvind

doi:10.7860/jcdr/2016/18208.8127

Cited by 24 publications

(27 citation statements)

References 33 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The most frequently used functional measurement tool used in the selected studies was the Oswestry Disability Index (ODI). However, one study (15) provided only the Japan Orthopedic Association score as a functional evaluation that could not be correlated with ODI; thus, it was excluded from the meta-analysis. Because another RCT did not provide available data for the meta-analysis (28), 10 studies (7 RCTs and 3 non-RCTs) were ultimately included in the meta-analysis.…”

Section: Search Resultsmentioning

confidence: 99%

“…Even though several reports have stated that TFEI obtained better clinical efficacy than ILEI in patients with LDH (9,(13)(14)(15)(16), conflicting studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that it also had the ability to spread the medication into the ventral space to a degree similar to that of TFEI (16)(17)(18)(19)(20). Furthermore, one study found that ILEI involved less pain or discomfort, and that it was less likely than TFEI to penetrate vascular structures during needle insertion (18).…”

Section: Data Collectionmentioning

confidence: 99%

“…Except for one RCT that was assessed as high risk, all RCTs were assessed as low risk in the random sequence domain (30). The domain that was most frequently biased was allocation concealment, of which 5 RCTs were rated as unclear because they did not adequately describe the procedure for allocation concealment (3,13,20,30,31), and 2 RCTs were graded as high risk because they showed flaws in the allocation process (15,28). One of the non-RCTs was rated as unclear in the domain of confounding variables because it did not clearly present the procedures of excluding the confounding factors (17,32,33).…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Among the 10 RCTs ultimately selected, no significant difference of clinical efficacy was found between TFEI and ILEI in 5 studies (3,18-20,31), another 4 reported (14,15,28,34) that TFEI obtained significantly better clinical effects than ILEI during 3-12 months follow-up periods, and 1 article (30) noted that TFEI was more effective in the short term but the superiority was diminished after 2 weeks. Between the 2 non-RCTs, one study (17) showed no significant difference between the 2 techniques, and the other study (9) stated that TFEI demonstrated better clinical efficacy than ILEI).…”

Section: Clinical Outcome Analysismentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

Lee

2018

Pain Phys

View full text Add to dashboard Cite

Background: Epidural injection (EI) is used to treat back or radicular pain from lumbosacral disc herniation (LDH). Although several reports have stated that the transforaminal approach in EI (TFEI) has an advantage in target specificity and yields better clinical efficacy than the interlaminar approach in EI (ILEI), other studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that ILEI also has the ability to spread medication into the ventral space to a degree similar to that of TFEI. There has been controversy about whether TFEI is superior to ILEI in clinical efficacy. Objectives: This systematic review and meta-analysis aimed to investigate whether TFEI is more useful than ILEI for achieving clinical outcomes in patients with LDH. Study design: A systematic review and meta-analysis using a random effects model on randomized controlled studies (RCT). Methods: A literature search was performed in MEDLINE, EMBASE, Cochrane review, and KoreaMed for studies published from January 1996 until July 2017. From those found fulfilling the search criteria, manuscripts that compared the clinical efficacy of steroids and control agents, such as local anesthetics or saline, in terms of pain control and functional improvement were included in this study. Exclusion criteria included a previous history of lumbosacral surgery, nonspecific low back pain, severe spinal stenosis, and severe disc degeneration. After reviewing titles, abstracts, and the full text of 6,711 studies; 12 studies were included in the qualitative synthesis. Data including pain scores, functional scores, and follow-up period were extracted from 10 studies and analyzed using a random effects model to obtain effect size and its statistical significance. The quality and level of evidence were analyzed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: In terms of pain control, TFEI showed significantly better short-term (2 weeks to 1 month) outcomes and slightly favorable long-term (4 - 6 month) outcomes, but without significance, in comparison with ILEI. In terms of functional improvement, TFEI also showed favorable short- and long-term outcomes, but without significance, in comparison with ILEI. TFEI had target specificity, required no additional cost and resources, and had equal applicability to ILEI. However, TFEI was more associated with a higher frequency of discomfort or adverse events during the procedure. Overall, better results were reported with TFEI over ILEI, but with low-grade evidence due to the inconsistency and imprecision of the selected studies. Limitation: Analyses of safety or adverse effects could not be performed due to a lack of available data from the included studies. Conclusions: Based on low-grade evidence, TFEI showed significantly better short-term pain control and slightly favorable outcomes in long-term pain reduction and short- and long-term functional improvement in comparison with ILEI. Key words: Epidural injection, interlaminar, transforaminal, meta-analysis, systemic review, pain, function

show abstract

Section: Search Resultsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Clinical Outcome Analysismentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

Lee

2018

Pain Phys

View full text Add to dashboard Cite

show abstract

“…Conservative treatments consist of neck immobilization, behavior modification, anti-inflammatory medications, physical therapy, and cervical traction are used to enlarge the neural foramen and reduce physiologic neck stress [2,6,7]. But after the failure of conservative treatment for compressive cervical radiculopathy and progressive or profound motor weakness, interventional management either surgical or nonsurgical such as epidural injections are considered in pain management of cervical radiculopathy [8][9][10]. Lumbar epidural steroid injection is now an established and commonly used treatment modality for the management of chronic low back pain and sciatica due to lumbar disc protrusion, and cervical epidural steroid injection was derived from this technique and has been applied as a treatment option for cervical radiculopathy [11,12].…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes and Satisfaction after Cervical Epidural Steroid Injection for Cervical Radiculopathy

Hashemi

Dadkhah

Taheri

et al. 2019

GMJ

View full text Add to dashboard Cite

Background: Cervical radiculopathy caused by disc herniation is a frequent public health issue with economical and socio-professional impacts. The objective of the present study is to evaluate the patient-reported outcomes and satisfaction from cervical epidural steroid injection during a 2-year follow-up. Materials and Methods: Results based on patients' reports from a previously performed intervention of cervical epidural steroid injection on patients with cervical radiculopathy due to cervical disc herniation are prospectively collected. Outcome measures are Neck Disability Index (NDI), numerical rating scale (NRS) for pain assessment, and 5-scale patient satisfaction questionnaire (PSQ) plus opioid medication for pain relief, additional injections, and progression to surgery. Results: Of total 37 cases, 34 were available for follow-up after 2-year postoperatively. The mean preoperative NDI was 21.17 and improved to 17.38, and the mean NRS was 7.7 and improved to 5.00; both were statistically significant. Mean patient satisfaction after 2 years was 3.17 out of 5. 11 cases needed additional injections, and 4 of patients proceeded to surgery. Conclusion: We showed that transforaminal cervical epidural steroid injection for cervical radiculopathy is an effective non-surgical treatment option, providing significant pain relief and functional improvement during 2-years follow-up along with higher-than-average patient satisfaction in most of our patients. [GMJ.2019;8:e1478]

show abstract

Epidural Approaches: Transforaminal, Interlaminar, and Caudal

Lee

2022

Minimally Invasive Spine Interventions

View full text Add to dashboard Cite

Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes

Cited by 24 publications

References 33 publications

Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

Patient-Reported Outcomes and Satisfaction after Cervical Epidural Steroid Injection for Cervical Radiculopathy

Epidural Approaches: Transforaminal, Interlaminar, and Caudal

Contact Info

Product

Resources

About