Efficacy of Lumbosacral Transforaminal Epidural Steroid Injections: A Systematic Review

Roberts, Scott T.; Willick, Stuart E.; Rho, Monica; Rittenberg, Joshua D.

doi:10.1016/j.pmrj.2009.04.008

Cited by 117 publications

(96 citation statements)

References 46 publications

(86 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many centres combine local anaesthetic and periradicular steroid injections in order to gain both diagnostic information and, potentially, longerterm pain relief for the patient. Evidence collated in SRs 31,77 confirms that transforaminal epidural steroid injections can be a clinically effective and cost-effective part of a management strategy for patients with radicular pain.…”

Section: Unanswered Questions and Future Researchmentioning

confidence: 98%

“…30 A SR of the topic, conducted in 2009, including nine RCTs, concluded that there is fair evidence that transforaminal epidural steroid injections are superior to placebo for treating radicular symptoms and good evidence that these injections can be used to avoid surgery. 31 However, the independent role of the anaesthetic and the steroid in this overall treatment effect is less clear. A double-blinded RCT comparing up to four nerve root injections using either anaesthetic alone (1 ml of 0.25% bupivacaine) or anaesthetic plus steroid [1 ml betamethasone (6 mg/ml)] in 55 patients with lumbar radicular pain found that the addition of betamethasone increased the proportion of patients deciding not to have surgery from 33% to 71% (p < 0.01).…”

Section: Diagnostic Selective Nerve Root Blocksmentioning

confidence: 99%

See 1 more Smart Citation

The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

Beynon

Hawkins²,

Laing³

et al. 2013

Health Technol Assess

View full text Add to dashboard Cite

Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/111/01. The contractual start date was in August 2010. The draft report began editorial review in February 2012 and was accepted for publication in October 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health.

show abstract

Section: Unanswered Questions and Future Researchmentioning

confidence: 98%

Section: Diagnostic Selective Nerve Root Blocksmentioning

confidence: 99%

The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

Beynon

Hawkins²,

Laing³

et al. 2013

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…25 In a systematic review, Roberts et al concluded that there was fair evidence supporting transforaminal epidural injections as superior to placebo for treating radicular symptoms, whereas there was good evidence that they should be used as a surgery-sparing intervention, and that they were superior to interlaminar ESIs and caudal ESIs for radicular pain. 26 Rho and Tang, in an evaluation of the efficacy of lumbar epidural steroid injections, concluded that there was strong evidence to support the use of lumbar transforaminal ESIs in patients with acute to sub acute unilateral radicular pain caused by a herniated nucleus pulposus or spinal stenosis. 27 They also concluded that a lumbar transforaminal epidural steroid injection is an effective surgery-sparing procedure that should be a part of conservative care in the management of LBP and radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of therapeutic efficacy of epidural steroid injections in lumbar spine with patients of chronic low back pain

Jati¹,

Danish²,

Sheikh³

et al. 2017

Int J Res Orthop

View full text Add to dashboard Cite

INTRODUCTIONLow back pain (LBP) is a most common problem. Approximately 80% Indian experience LBP during their lifetime. An estimated 15-20% develops protracted pain, and 2-8% has chronic pain. Every year, 3-4% of the population is temporarily disabled, and 1% of the working-age population is disabled totally and permanently because of LBP.1 LBP is second only to the common cold as a cause of lost work time; it is the fifth most frequent cause for hospitalization and the third most common reason to undergo a surgical procedure. LBP is defined as chronic after 3 months because most normal connective tissues heal within 6-12 weeks unless pathoanatomic instability persists. A slowed rate of tissue repair in the relatively avascular intervertebral disc may impair the resolution of chronic LBP. Traumatic or degenerative conditions of the spine are the most common causes of chronic LBP. A number of anatomic structures of the lumbar spine have been considered as the origin of LBP. [2][3][4][5][6] Many studies have shown significant improvement with epidural injections with or without steroids in patients with chronic LBP. Among the multiple interventions used in managing chronic spinal pain; lumbar epidural injections have been used extensively to treat lumbar radicular pain. Epidural steroid injections (ESIs) are a common treatment option for many forms of LBP and leg pain. They have been used for low back problems since ABSTRACT Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in managing chronic low back pain (LBP) along with surgical intervention. Cost effectiveness and affordability has become the cornerstone of evidence-based medicine, and has an influence on coverage decisions, especially in developing countries such as India. LBP is a common problem. The aim of this study was to find the therapeutic efficacy of epidural steroid injections (ESIs) in chronic LBP. Methods: 50 patients presenting with LBP with or without radiculopathy treated with ESIs were prospectively followed for average duration of 12 months. Results: Fifty patients were included in this study with average age 51.02±7.1, out of these 26 (52%) were males and 24 (48%) females. Significant pain relief (>50%) was demonstrated in 43 (71%) of patients and functional status improvement was demonstrated by a reduction of 40% in Oswestry disability index (ODI) score in 49 (81%) patients. Conclusions: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.

show abstract

“…Transforaminal epidural steroid injections (TFESI) are minimally invasive and safe for treating lumbar radiating pain, and it's popularity is growing among physicians [1]. Many studies demonstrated effectiveness of the TFESIs in managing lumbar radiating pain [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies demonstrated effectiveness of the TFESIs in managing lumbar radiating pain [1,2]. It is reported that 50-75% of patients with lumbar radiating pain had temporary relief after TFESI.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Lumbar Stabilization Exercise Combined with Transforaminal Epidural Steroid Injection for Lumbar Radiating Pain

Oh¹,

Lee²,

Ryu³

2016

Int J Phys Med Rehabil

View full text Add to dashboard Cite

Objective: The purpose of this study was to evaluate the effects of exercises combined with transforaminal epidural steroid injection (TFESI) in patients with lumbar radiating pain. Methods:Among 359 patients who were treated with TFESI for lumbar radiating pain, 118 subjects were eligible and analyzed. The injections were performed for all patients with 20 mg triamcinolone, 1 ml lidocaine (0.5%) and 0.5 ml normal saline. Exercise group (n=45) received TFESI as well as additional stabilization exercise for 30 minute sessions over 3 weeks (three times weekly), while control group (n=73) received TFESI and did not receive any additional stabilization exercise. The effects were evaluated using Numercal Rating Scale (NRS) at pre-injection, 4 weeks, 8 weeks, 12 weeks and 24 weeks after injection.Results: Between Exercise and Control group, there were no significant differences in sex, age and baseline NRS score (P>0.05). Compared with that of the baseline, mean NRS scores decreased significantly in both groups after 4 weeks. The improvement sustained until 24 weeks in exercise group, while mean NRS scores slightly increased in control group. The proportion of treatment success at 24 weeks were 68.9% in exercise group and 41.1% in control group (p<0.05, odds ratio=3.17). The exercise group had moderate effect size (d=0.568) compared to the control group at 24 weeks. Conclusion:Lumbar stabilization exercise combined with TFESI was more effective than TFESI alone for reducing lumbar radiating pain and reduced the rate of recurrence.

show abstract

Efficacy of Lumbosacral Transforaminal Epidural Steroid Injections: A Systematic Review

Cited by 117 publications

References 46 publications

The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

Evaluation of therapeutic efficacy of epidural steroid injections in lumbar spine with patients of chronic low back pain

The Efficacy of Lumbar Stabilization Exercise Combined with Transforaminal Epidural Steroid Injection for Lumbar Radiating Pain

Contact Info

Product

Resources

About