A Randomized, Controlled, Double-Blind Trial of Fluoroscopic Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation and Radiculitis

Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A; Pampati, Vidyasagar; Damron, Kim S; Boswell, Mark V.

doi:10.1097/brs.0b013e31823294f2

Cited by 97 publications

(148 citation statements)

References 58 publications

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“…These results are similar to the patients receiving caudal epidural injections either with or without steroids with disc herniation and radiculitis. 14 Despite increasing utilization of lumbar transforaminal epidural injections, significant debate continues regarding their effectiveness. Buenaventura et al in a systematic review of therapeutic lumbar transforaminal epidural steroid injections, evaluated 4 randomized trials based on cochrane musculoskeletal review group criteria, with criteria of short-term relief as <6 months and long-term relief as >6 months.…”

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

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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.

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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

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Section: Radicular Pain Secondary To Disc Herniationmentioning

confidence: 99%

“…[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. 18,19,25,26 Long-term outcomes were assessed in only 6 studies 16,19,20,[24][25][26][27] and were significant compared with baseline, but ESI was no more effective than control injections, when long-term outcomes The US Preventive Task Force (USPTF) system 2 was used to determine the level of evidence in the reviewed studies ( Table 1).…”

Section: Radicular Pain Secondary To Disc Herniationmentioning

confidence: 99%

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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“…1,2 To ensure an optimal response to this intervention, the injectate must be deposited within the epidural space in close proximity to the site of the pathology. 3 The approaches commonly used to inject corticosteroid are 1) directly through an epidural needle or 2) via a catheter threaded into the epidural space. 4 For both techniques, fluoroscopy is the standard of care to confirm that the epidural needle or catheter tip is properly positioned prior to injection.…”

Section: Résumémentioning

confidence: 99%

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

McAuliffe

Pickworth

DiRenna

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids. Methods We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10 mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection. Results Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement. Conclusion This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population. RésuméObjectif Il peut être difficile de déterminer le positionnement du cathéter péridural et de placer de façon précise les corticostéroïdes au site de la lésion chez les adultes souffrant de maux de dos chroniques. La fluoroscopie est considérée comme la norme de soins pour guider le positionnement du cathéter péridural et l'injection subséquente chez les patients recevant des corticostéroïdes par voie péridurale, mais la technique comporte certaines limites. Nous avons émis l'hypothèse que la stimulation électrophysiologique réalisée à l'aide du test de Tsui était faisable pour déterminer le positionnement adéquat du cathéter péridural chez les adultes souffrant de maux de dos Author contributions Niamh McAuliffe made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafted the article and revised the manuscript; and approved the final version to be published. Sharon Pickworth made substantial contributions to conception and design, acquisition of data; revised the manuscript; and approved the final version to be published. Tania DiRenna made substantial contributions to conception and design, acquisition of data; and revised the manuscript;...

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A Randomized, Controlled, Double-Blind Trial of Fluoroscopic Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation and Radiculitis

Abstract: Caudal epidural injection with local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis. The present evidence illustrates potential superiority of steroids compared with local anesthetic at 1-year follow-up.

Cited by 97 publications

References 58 publications

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

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

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

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