A Systematic Review of the Effectiveness of CT-Guided, Lumbar Transforaminal Injection of Steroids

Bui, J.; Bogduk, Nikolai

doi:10.1111/pme.12243

Cited by 24 publications

(21 citation statements)

References 21 publications

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“…68 Concerning epidural injections, imaging modalities used for guidance include fluoroscopy, CT and MRI. 16,17,50,51,[69][70][71] Ultrasound guidance with navigation systems can be used for periradicular (i.e. transforaminal) injections.…”

Section: Epidural Injectionsmentioning

confidence: 99%

“…72 Recent systematic reviews support that there is good evidence for epidural injections in cases of radiculitis due to intervertebral disc herniation and fair evidence in cases of radiculitis due to spinal stenosis; in all cases, there is evidence illustrating superiority of steroids mixed to local anaesthetic rather than local anaesthetic alone. [13][14][15][69][70][71]73 Epidural injections are rarely associated with minor complications and side effects, such as dural puncture, pain exacerbation, vasovagal reaction and headache; all these side effects and complications do not involve any permanent impairment. 68 However, rarely there are reported cases of catastrophic spinal cord injuries post epidural infiltrations with steroids and local anaesthetic; the number of these reported cases suggests that the risk is not negligible.…”

Section: Epidural Injectionsmentioning

confidence: 99%

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A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

Filippiadis

Kelekis

2016

BJR

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Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques.

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Section: Epidural Injectionsmentioning

confidence: 99%

Section: Epidural Injectionsmentioning

confidence: 99%

A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

Filippiadis

Kelekis

2016

BJR

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“…Limited evidence currently exists in terms of the effectiveness and safety differences between these techniques. For instance, a recent literature review by Bui and Bogduk [ 7 ] concluded that CT-guided lumbar transforaminal injection of corticosteroids is neither more effective nor safer than the fluoroscopy-guided injections but that CT is associated with significantly higher radiation doses than conventional fluoroscopy. Ultrasound has gained popularity and maybe a safe alternative to the other radiological imaging modalities [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Safety of Epidural Corticosteroid Injections

et al. 2015

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Background and ObjectiveEpidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports.MethodsStudies were identified by searching PubMed MEDLINE, Ovid MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Library to retrieve all available relevant articles. Publications from the last 20 years (September 1994 to September 2014) were considered for further analysis. Studies selected were English-language original articles publishing results on complications related to the technique used for cervical and lumbar ESIs. The studies had to specify the approach used for injection. All studies that did not fulfil these eligibility criteria were excluded from further analysis.ResultsOverall, the available literature supports the view that serious complications following injections of corticosteroid suspensions into the cervical and lumbar epidural space are uncommon, but if they occur they can be devastating.ConclusionsThe true incidence of such complications remains unclear. Direct vascular injury and/or administration of injectates intra-arterially represent a major concern and could account for the vast majority of the adverse events reported. Accurate placement of the needle, use of a non-particulate corticosteroid, live fluoroscopy, digital subtraction angiography, and familiarisation of the operator with contrast patterns on fluoroscopy should minimise these risks. The available literature has several limitations including incomplete documentation, unreported data and inherent bias. Large registries and well-structured observational studies are needed to determine the true incidence of adverse events and address the safety concerns.

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“…The CT-guided approach may have an advantage thanks to the improved soft tissue contrast and ability to target the cyst directly, on the other hand, this may involve greater radiation exposure. [10,11] Chazen et al [12] reported successful pain relief with CT-guided PCR on five patients who failed prior fluoroscopic rupture. Either with fluoroscopy or CT guidance, PCR is achieved similarly by forceful pressurization.…”

Section: Discussionmentioning

confidence: 99%

Is fluoroscopy-guided percutaneous rupture of facet cyst an alternative to surgery? A case report

Gündüz

Şencan

Erçalık

et al. 2018

Turk J Phys Med Rehab

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Lumbar intraspinal synovial cysts (LISCs) are rare cause of the lumbosacral radicular syndrome. Fluoroscopy-guided percutaneous cyst rupture (PCR) is an option in the treatment. This report introduces long-term symptom relief after fluoroscopy-guided PCR of LISC. A 73-year-old patient presented with low back pain radiating to right leg. L5 radiculopathy was suspected by physical examination; however, an intraspinal cystic mass was visualized through imaging studies. The patient reported immediate pain relief after fluoroscopy-guided PCR, which sustained for one year. In conclusion, fluoroscopy-guided PCR appears to be a safe and effective treatment option and should be considered before surgery in patients with LISCs.

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A Systematic Review of the Effectiveness of CT-Guided, Lumbar Transforaminal Injection of Steroids

Abstract: The evidence-base for CT-guided lumbar transforaminal injection of steroids is meagre. This intervention is not more effective than fluoroscopy-guided injections and is not demonstrably safer.

Cited by 24 publications

References 21 publications

A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

Safety of Epidural Corticosteroid Injections

Is fluoroscopy-guided percutaneous rupture of facet cyst an alternative to surgery? A case report

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