Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study

Abstract

Background: Previous studies have shown varying results between lumbosacral transforaminal epidural steroid injections (TFESIs) performed with particulate versus non-particulate corticosteroids. The purpose of this study was to investigate the difference in pain relief and functional improvement between particulate and nonparticulate lumbosacral TFESIs in patients who had undergone both injections, sequentially. Methods: This was a self-controlled, retrospective study of 20 patients who underwent both a methylprednisolone and a dexamethasone TFESI to the same vertebral level and side. Primary outcomes included pain relief according to the visual analogue scale (VAS) and functional improvement determined by a yes/no answer to questions regarding mobility and the activities of daily living. Post-injection data was recorded at 2, 3, and 6 months. Results: A decrease in VAS scores of-3.4 ± 3.0 (mean ± standard deviation),-3.1 ± 3.1, and-2.8 ± 3.4 was seen for the methylprednisolone group at 2, 3, and 6 months, respectively. Similar decreases of-3.9 ± 3.5,-3.4 ± 2.8, and-2.3 ± 3.4 were seen in the dexamethasone group. There was no significant difference in pain relief at any point between the two medications. The percentage of subjects who reported improved function at 2, 3, and 6 months was 65%, 51%, and 41%, respectively, for the methylprednisolone group and 75%, 53%, and 42% for the dexamethasone group. Conclusions: These findings support the use of non-particulate corticosteroids for lumbosacral TFESIs in the context of documented safety concerns with particulate corticosteroids.

Physiology and Pharmacology of Epidurally Administered Drugs

“…There have been no serious complications attributed to the use of Table 5. Physicochemical properties of corticosteroids [86].…”

“…Recent literature documents that there is no significant difference in pain relief at any point between non-particulate and particulate steroids. There are recommendations that non-particulate steroid preparations should be considered as first-line agents when performing ESI [86,87]. However, further studies are necessary to compare corticosteroid preparations.…”

Safety of epidural steroids: a review

“…Conversely, Park et al [ 81 ] reported that the nonparticulate steroid dexamethasone was statistically less effective than the particulate steroid in terms of pain relief. In 2020, Donohue et al [ 82 ] reported that there was no significant difference in pain relief at any point between nonparticulate and particulate steroids and recommended the use of nonparticulate corticosteroids in ESI given the safety concerns associated with particulate corticosteroids. Considering the potential risk of catastrophic complications, nonparticulate steroid preparations should be considered as first-line agents when performing ESI.…”

Relationship between needle depth for lumbar transforaminal epidural injection and patients' height and weight using magnetic resonance imaging

“…Epidural injections such as the interlaminar epidural block and transforaminal epidural injection (TFEI) have been widely used for the treatment of patients with low back pain and lumbosacral radicular pain [ 1 – 4 ]. As injection agents, corticosteroids and local anesthetics are commonly used to reduce pain and inflammation [ 5 – 7 ]. Both interlaminar and transforaminal block techniques are effective for lumbar radiating pain and have low complication rates, but the transforaminal technique can be more effective than the interlaminar [ 8 , 9 ].…”