scholarly journals Comparison of the Oblique Interlaminar and Transforaminal Lumbar Epidural Steroid Injections for Treatment of Low Back and Lumbosacral Radicular Pain

2021 ◽  
Vol Volume 14 ◽  
pp. 407-414
Author(s):  
Eun-Ji Choi ◽  
Soon Ji Park ◽  
Yeong-Min Yoo ◽  
Ji-Uk Yoon ◽  
Sang-Wook Shin ◽  
...  
Keyword(s):  
Radicular Pain ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

scholarly journals Epidural Steroids in the Management of Chronic Spinal Pain: A Systematic Review

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 185-212
Author(s):  
Salahadin Abdi
Keyword(s):  
Spinal Pain ◽  
Radicular Pain ◽  
Low Back ◽  
Short Term ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Pain ◽  
Epidural Steroid ◽  
Chronic Spinal Pain

Background: Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain. Objective: To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions. Study Design: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used. Methods: Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. Three reviewers independently assessed the trials for the quality of their methods. Subgroup analyses were performed among trials with different control groups, with different techniques of epidural injections (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term). Outcome Measures: The primary outcome measure is pain relief. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term improvement is defined as 6 weeks or less, and long-term relief is defined as 6 weeks or longer. Results: In managing lumbar radicular pain with interlaminar lumbar epidural steroid injections, the evidence is strong for short-term relief and limited for long-term relief. In managing cervical radiculopathy with cervical interlaminar epidural steroid injections, the evidence is moderate. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar radicular pain is strong for short-term and moderate for long-term relief. The evidence for cervical transforaminal epidural steroid injections in managing cervical nerve root pain is moderate. The evidence is moderate in managing lumbar radicular pain in post lumbar laminectomy syndrome. The evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief, in managing chronic pain of lumbar radiculopathy and postlumbar laminectomy syndrome. Conclusion: There is moderate evidence for interlaminar epidurals in the cervical spine and limited evidence in the lumbar spine for long-term relief. The evidence for cervical and lumbar transforaminal epidural steroid injections is moderate for long-term improvement in managing nerve root pain. The evidence for caudal epidural steroid injections is moderate for long-term relief in managing nerve root pain and chronic low back pain. Key words: Spinal pain, low back pain, cervicalgia, epidural steroids, interlaminar, caudal, transforaminal, radiculopathy, axial pain, postlaminectomy syndrome, failed back surgery syndrome.

scholarly journals Epidural Steroid Injections for Low Back Pain: A Narrative Review

2021 ◽  
Vol 19 (1) ◽  
pp. 231
Author(s):  
Massimiliano Carassiti ◽  
Giuseppe Pascarella ◽  
Alessandro Strumia ◽  
Fabrizio Russo ◽  
Giuseppe Francesco Papalia ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radicular Pain ◽  
Narrative Review ◽  
Low Back ◽  
Current Application ◽  
Medical Treatments ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients’ quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.

A Comparative Effectiveness Evaluation of Percutaneous Adhesiolysis and Epidural Steroid Injections in Managing Lumbar Post Surgery Syndrome: A Randomized, Equivalence Controlled Trial

2009 ◽  
Vol 6;12 (6;12) ◽  
pp. E355-E368
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Facet Joint ◽  
Low Back ◽  
Lumbar Surgery ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Post Surgery ◽  
Group I ◽  
Group Ii ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, and facet joint pain among other causes. Even though fluoroscopically directed caudal epidural injections and facet joint interventions are effective in some patients, others continue to suffer with chronic persistent pain. Percutaneous adhesiolysis with target delivery of medications has been demonstrated to be effective in these patients. However, the evidence for percutaneous adhesiolysis in managing post surgery syndrome has been questioned, coupled with a paucity of controlled trials. Study Design: A randomized, equivalence, controlled trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objectives: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain in post surgery syndrome and compare with fluoroscopically directed caudal epidural steroid injections. Methods: Patients were randomly assigned to one of 2 groups: Group I (60 patients) receiving caudal epidural injections with catheterization up to S3 with local anesthetic, steroids, and 0.9% sodium chloride solution serving as the control group, and Group II (60 patients) receiving percutaneous adhesiolysis with targeted delivery of lidocaine, 10% hypertonic sodium chloride solution, and non-particulate Betamethasone serving as the intervention group. Randomization was performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12 months post treatment. Significant pain relief was described as 50% or more, whereas significant improvement in the disability score was defined as a reduction of 40% or more. Results: Significant pain relief (≥ 50%) and functional status improvement was recorded in 73% of patients in Group II versus 12% in Group I (P < 0.001). The average procedures per year were 3.5 with an average total relief of 42 out of 52 weeks in Group II and 2.2 procedures with total relief per year of 13 weeks in Group I (P < 0.001). Limitations: The results of this study are limited by potentially inadequate double blinding, by the lack of a placebo group, and the preliminary report of one-year follow-up. Conclusions: Percutaneous adhesiolysis in chronic function-limiting, recalcitrant low back pain in post lumbar surgery syndrome demonstrated effectiveness in 73% of the patients. Key words: Post lumbar surgery syndrome, post lumbar laminectomy syndrome, chronic low back pain, epidural adhesions, epidural steroid injections, percutaneous adhesiolysis, epidural fibrosis, spinal stenosis, randomized trial, comparative effectiveness

scholarly journals Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Masoud Hashemi ◽  
Mohamad Reza Aryani ◽  
Sirus Momenzadeh ◽  
Seyed Sajad Razavi ◽  
Gholamreza Mohseni ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

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