Lateral Parasagittal Versus Midline Interlaminar Lumbar Epidural Steroid Injection for Management of Low Back Pain with Lumbosacral Radicular Pain

Ghai, Babita; Vadaje, Kaivalya Sadashiv; Wig, Jai Dev; Dhillon, Mandeep Singh

doi:10.1213/ane.0b013e3182910a15

Cited by 63 publications

(61 citation statements)

References 30 publications

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“…Candido et al [15] reported that 100 % (29/29) of patients in a parasagittal interlaminar group and 75% (21/29) of patients in a transforaminal group demonstrated anterior epidural spreading. Ghai et al [16] reported that the lateral parasagittal technique was significantly more effective than the midline approach for pain relief and improvement in disability in the management of low back pain with radicular leg pain.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

2014

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BackgroundRecently, there have been several case reports and retrospective studies about the incidence of intradiscal (ID) injection during transforaminal epidural steroid injection (TFESI). Inadvertent ID injection is not a rare complication, and it carries the risk of developing diskitis, although there has been no report of diskitis after TFESI. We prospectively evaluated the incidence of inadvertent ID injection during lumbar TFESI and analyzed the contributing factors.MethodsTen patients received 2-level TFESI, and the remaining 229 patients received 1-level TFESI. When successful TFESI was performed, 2 ml of contrast dye was injected under real-time fluoroscopy to check for any inadvertent ID spread. A musculoskeletal radiologist analyzed all magnetic resonance images (MRIs) of patients who demonstrated inadvertent ID injection. When reviewing MRIs, the intervertebral foramen level where ID injection occurred was carefully examined, and any anatomical structure which narrowing the foramen was identified.ResultsAmong the 249 TFESI, we identified 6 ID injections; thus, there was an incidence of 2.4%. Four patients had isthmic spondylolisthesis, and the level of spondylolisthesis coincided with the level of ID injection. We further examined the right or left foramen of the spondylolisthesis level and identified the upward migrated disc material that was narrowing the foramen.ConclusionsInadvertent ID injection during TFESI is not infrequent, and pain physicians must pay close attention to the type and location of disc herniation.

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Section: Discussionmentioning

confidence: 99%

Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

2014

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“…[16][17][18][19][20][21][22][23][24][25][26][27] Of those studies, 5 included a control group, which was administered NSEI. 18,19,[24][25][26] ESI was superior or suggested to be superior to NSEI in 4 of the 5 studies.…”

Section: Radicular Pain Secondary To Disc Herniationmentioning

confidence: 99%

“…The parasagittal injection group required fewer injections over the study period. 21 This level I evidence suggests that for interlaminar approaches, a lateral parasagittal (paramedian) approach is better, but the approach does not affect outcomes in transforaminal injections.…”

Section: Various Transforaminal or Interlaminar Approachesmentioning

confidence: 99%

“…All of these studies demonstrated improvement over baseline pain at all short-term time points. 4,14,[17][18][19][20][21][23][24][25][26]32,34,36,37,39,43,44 Nine studies followed up patients for 1 to 2 years, with 8 demonstrating improvement over baseline at long-term followup. 4,14,20,[24][25][26]43,44 In the long-term studies, patients typically received more than 1 injection, most commonly 4 over the course of 1 year and 6 over the course of 2 years.…”

Section: Multiple Injectionsmentioning

confidence: 99%

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When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Kiritsy¹,

Siefferman²

2016

Topics in Pain Management

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L ow back pain (LBP) is a common symptom, and patients often present to interventional pain specialists for an epidural steroid injection (ESI). However, much of the data surrounding the efficacy of ESI for LBP is conflicting. Part 1 of this 2-part series is a general review of the literature with best available recommendations. In part 2, some of the more relevant articles analyzed are reviewed as an appendix.The goal of this systematic review article is to determine under which conditions an ESI may be helpful for LBP. All meta-analyses and clinical trials known by the authors to have been published within the last 5 years were reviewed.In the review, there was a vast degree of heterogeneity in causes of LBP, injection approach, volume, and composition. The data demonstrated consistent level I evidence supporting the use of ESI for short-term relief of radicular pain from herniated discs, with a transforaminal approach being the most common technique. For spinal stenosis, epidural injections with or without steroids were equally effective and superior to placebo or to no epidural injection.The results suggest that the cause of LBP is likely an important factor for determining whether an epidural injection will Learning Objectives: After participating in this CME activity, the physician should be better able to: 1. Explain the current literature regarding the efficacy of lumbar epidural injections for low back pain. 2. Understand the effect that approach may have on the efficacy of epidural injections. 3. Describe variables in injected medications and how they affect the efficacy of lumbar epidural injections. 4. Increase awareness about the challenges that exist in studying epidural injection efficacy for low back pain.

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“…There have been many attempts to validate each technique as better approach in terms of long term efficacy, however a clear and data driven conclusion is yet to be had [118,119]. In some studies, when compared to TFESI, the ILESI provided less pain relief and needed greater number of injections [120,121]. There is at least one study that did not find a significant difference in outcomes when comparing fluoroscopically-guided TFESI with ILESI, however in this study all subjects were limited to a single injection [122].…”

Section: Efficacymentioning

confidence: 99%

Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options

2015

J Orth Rheumatol

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Background: In the United States, low back pain remains a common problem and a number one reason to see a physician in the outpatient setting. Etiology is complex and likely multifactorial and includes; degenerative disc disease, zygapophysial joint arthritis, vertebral misalignment, muscle strain, ligament sprain, myofascial pain, among others. Based on evidence of increased inflammatory response in disc herniation and degenerative discs, epidural steroid injections (ESI) have been used to treat lumbosacral radicular pain. Objective:To focus on the appropriate use of lumbar ESI in treating lumbosacral radicular pain in the United States, comparing and contrasting transforaminal, interlaminar, and caudal approaches for steroid delivery, as well as a comparison of commonly used steroid preparations.Methods: PubMED, MEDLINE, and OVID databases were reviewed utilizing the following subject headings: low back pain, epidural steroid injections, transforaminal epidural steroid injections (TFESI), interlaminar epidural steroid injections (ILESI), and caudal epidural steroid injections (CESI) dated from 2000 to 2014. The bibliographies of major articles and reviews were also cross-referenced for additional sources.Results: A number of articles that included randomized control trials, comprehensive and systematic reviews, and meta-analyses were found. These provided a broad, detailed overview of the subject, that we used to explore the data surrounding use of ESI for treatment of lumbosacral radicular pain. Conclusions:Most agree that the evidence for epidural steroid injection efficacy is strongest for short term relief of lumbosacral radicular pain. Most of the systemic reviews have agreed that the strongest evidence for TFESI use is for relief of unilateral lumbosacral radicular pain. The evidence suggests using ILESI in patients with bilateral and/ or multi-level lumbosacral radicular pain. The data correlates efficacy of CESI in low level bilateral or multilevel lumbosacral radicular pain as well as in patients with history of lumbar surgery. Introduction EpidemiologyIn the United States, low back pain remains common. Approximately two-thirds of the population has low back pain at some time in their lives and approximately 26% of adults surveyed admit to having low back pain within the last three months [1]. Back pain is the fifth most common reason for all physician visits [2] and the second most common symptom-related reason for clinician visits [3,4]. The 2010 Global Burden of Disease (GBD) results showed that there is a very high prevalence and burden from low back pain throughout the world [5]. Low back pain was found to have the sixth highest burden of the 291 conditions studied, and caused more disability than any other condition. It is well known that back pain accounts for a large proportion of health care expenditures and that these expenditures have been increasing substantially [6]. In fact, these expenditures have been increasing more rapidly than overall health expenditures [6]. Taken together ...

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Lateral Parasagittal Versus Midline Interlaminar Lumbar Epidural Steroid Injection for Management of Low Back Pain with Lumbosacral Radicular Pain

Abstract: Epidural steroid injection administered with the PIL approach was significantly more effective for pain relief and improvement in disability than the MIL approach for 6 months in the management of low back pain with lumbosacral radicular pain.

Cited by 63 publications

References 30 publications

Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options

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