A systematic review and network meta‐analysis comparing different epidural steroid injection approaches

Abstract

BackgroundLow back pain (LBP) and lumbosacral radiculopathy are frequent disorders that cause nerve root injury, resulting in a variety of symptoms ranging from loss of sensation to loss of motor function depending on the degree of nerve compression.ObjectivesThe goal of this study was to investigate the effectiveness of various epidural injection procedures in adult LBP patients.Study DesignSystematic review and network meta‐analysis.SettingEgypt.MethodsPubMed, Scopus, Web of Science, Cochrane Database, and Embase were used to conduct an electronic literature search. We included RCTs, cohorts, case controls, patients 30 years old with a clinical presentation of low back pain, and comprehensive data on the effects of the intervention on patients with lumbosacral radicular pain who got epidural steroid injections via various techniques. Only papers written in English were eligible.ResultsOur analysis showed that parasagittal intralaminar (PIL) was the most effective approach in decreasing VAS (0–10) in the short term (< 6 months) (MD = −1.16 [95% CI −2.04, −0.28]). The next significant approach was transforaminal (TF) (MD = −0.37 [95% CI −1.14, −0.32]) in the long term; TF was the most effective approach (MD = −0.56 [95% CI −1, −0.13]). According to VAS (0–100) in the short term (< 6 months), our analysis showed an insignificant difference among the injection approaches and in the long term; TF was the most effective approach (MD = −24.20 [95% CI −43.80, −4.60]) and the next significant approach was PIL (MD = −23.89 [95% CI −45.78, −1.99]).LimitationsThe main limitations are the heterogeneity encountered in some of our analyses in addition to studies assessed as high risk of bias in some domains.ConclusionTF was the most effective steroid injection approach. In decreasing VAS for short‐term PIL and TF were the most significant approaches, but TF was the most effective approach in decreasing VAS for the long term. Also, TF was the most effective approach in decreasing ODI for the long term.

Failed back surgery syndrome—terminology, etiology, prevention, evaluation, and management: a narrative review

“…The transforaminal approach to ESI is particularly effective in diagnosing and treating radicular pain by targeting specific spinal levels. This approach has been shown to provide significant short-term relief from radicular pain and offer superior long-term pain reduction and functional improvements compared to other injection techniques [ 72 ].…”

Clinical Application of an Augmented Reality Navigation System for Transforaminal Epidural Injection: A Randomized Controlled Trial

“…Lower back pain with radicular symptoms represents a prevalent cause of disability among the adult population [12][13][14]. Lumbosacral transforaminal epidural injection is a commonly performed procedure for the treatment and diagnosis of radiculopathy [15]. Although this procedure is relatively safe and uncomplicated, accurately positioning the needle to avoid bones and nerves can be challenging in patients with severe anatomical degeneration or deformities, potentially increasing the risk of complications [16].…”