Response to Steroid and Duration of Radicular Pain as Predictors of Surgical Outcome

Derby, Richard; Kine, Garrett; Saal, Jeffrey A.; Reynolds, James B.; Goldthwaite, Noel; White, Arthur H.; Hsu, Ken Y.; Zucherman, James

doi:10.1097/00007632-199206001-00020

Cited by 179 publications

(73 citation statements)

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“…The latter, however, is time-consuming and may be performed only on-site in appropriately equipped clinical institutions with considerable expenditure of resources. 7,8 US is already used successfully to guide a variety of instillation procedures in different anatomic regions, showing many benefits: direct visualization of the target of interest, real-time needle guidance, visualization of the spread of local anesthetics and thus minimal risk of complications, potential for dose reduction of local therapeutics, and shortening of procedure time, just to mention a few.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Imaging guidance has increased the precision of spinal injection, and CT or fluoroscopy is, to date, preferentially used. [7][8][9][10] US guidance for spinal injection is a recent development but, according to the literature, seems promising. [11][12][13][14][15][16][17][18][19][20] US has proved sufficiently reliable and accurate in the demonstration of lumbar paravertebral anatomy, [11][12][13][14]21 and the feasibility of US-guided injection therapy at the spine has also been demonstrated in several studies.…”

mentioning

confidence: 99%

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A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

Loizides¹,

Gruber²,

Peer³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT or fluoroscopic guidance. The benefits of US-guided instillation procedures have been shown in many studies. We conducted this study to simplify an US-guided approach to the lumbar spinal nerves and to assess the feasibility and preliminary accuracy by means of CT and anatomic dissection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

Loizides¹,

Gruber²,

Peer³

et al. 2011

AJNR Am J Neuroradiol

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“…In contrast, the transforaminal (or periradicular) injection of corticosteroids under fluoroscopic guidance delivers high concentrations of therapeutic agents to the site of pathology [9]. But, the evidence for transforaminal injection of steroids is more contentious and there are only a few randomised controlled trials examining the efficacy of this treatment for alleviating radicular pain and disability.…”

Section: Introductionmentioning

confidence: 99%

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Quraishi

2011

Eur Spine J

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Background Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection. Study designHence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up. Methods The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials. Results The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followedup patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: -0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: -0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups. ConclusionThe current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature.

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“…A cervical transforaminal injection requires placement of a needle into the neuroforamen from an anterolateral approach. By targeting the anterior epidural space at a single level, transforaminal injections do provide more localized medication delivery [13,14], and they are particularly target specific for foraminal and extraforaminal disc herniations [15,16].…”

Section: Introductionmentioning

confidence: 99%

Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives

Smuck

Demirjian

Kennedy

2013

Curr Phys Med Rehabil Rep

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The goal of cervical epidural corticosteroid injections is to ameliorate pain from cervical radiculopathy. Controversy remains regarding the use and optimal delivery route of epidural medications in the cervical spine. The purpose of this review article is to compare the risks and benefits associated with cervical interlaminar and transforaminal epidural injections, and to describe alternatives to their use.

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Response to Steroid and Duration of Radicular Pain as Predictors of Surgical Outcome

Cited by 179 publications

References 0 publications

A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives

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