Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar<i>versus</i>bilateral transforaminal approach

Şencan, Savaş; Edipoğlu, İpek Saadet; Celenlioglu, Alp Eren; Yolcu, Günay; Gündüz, Osman Hakan

doi:10.3344/kjp.2020.33.3.226

Cited by 16 publications

(26 citation statements)

References 30 publications

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“…In total, 3792 participants (1765 males, 1836 females and 191 participants of undisclosed gender14 15 were randomised to one of the 60 comparison groups. In total, 17 studies evaluated rehabilitation therapy or multimodal care,14 16–31 11 assessed epidural injections,32–42 7 evaluated oral medications,15 43–48 6 assessed calcitonin,49–54 2 evaluated acupuncture55 56 and 1 assessed spinal manipulation 57. Thirty-eight trials were conducted at tertiary care or university affiliated centres and six at medical/rehabilitation clinics 18 24 35–38.…”

Section: Resultsmentioning

confidence: 99%

“…Although 31 studies met six or more criteria, only 9 were considered to have low risk of bias 19 20 24 27 28 31 37 42 43 56. Among the remaining 22 studies that met six or more criteria, 13 failed to explicitly describe and/or use appropriate randomisation procedures, allocation concealment or both16–18 30 32–34 39 41 48 52 54 57; 3 had severe flaws due to high cross-over rates,21 22 25 which made the intention-to-treat analyses uninterpretable and 6 had other serious flaws including premature stopping of the trial,47 large number of participants lost to follow-up40 and small sample size (less than 30 participants per arm) 26 29 46 55…”

Section: Resultsmentioning

confidence: 99%

“…There is very low-quality evidence from one study (N=67) 41 that interlaminar steroid injection improves pain and walking distance in the intermediate but not in the short term compared with transforaminal steroid injection.…”

Section: Open Accessmentioning

confidence: 99%

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Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

et al. 2022

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ObjectivesNeurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.DesignA systematic review.Data sourcesCENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020.Eligibility criteriaWe only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis.ResultsOf 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review.ConclusionsThere is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.PROSPERO registration numberCRD42020191860.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

et al. 2022

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“…Sencan et al performed a randomized comparative trial of intralaminar LESI (ILESI) vs bilateral transforaminal epidural steroid injection (TFESI) for 67 patients with NC in the setting of central canal lumbar stenosis. 147 Each group received either fluoroscopic guided TFESI or ILESI with 80 mg of methylprednisolone plus bupivacaine and were followed for 3 months. Both groups had significant improvement in pain (NRS) and function (ODI) at all time points.…”

Section: Epidural Steroid Injectionsmentioning

confidence: 99%

Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

Deer¹,

Grider²,

Pope³

et al. 2022

JPR

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Introduction Lumbar spinal stenosis (LSS) is a common spinal disease of aging with a growing patient population, paralleling population growth. Minimally invasive treatments are evolving, and the use of these techniques needs guidance to provide the optimal patient safety and efficacy outcomes. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for guidance on the prudent use of the innovative minimally invasive surgical therapies for the treatment of symptomatic LSS. The executive board nominated experts spanning anesthesiology, physiatry, orthopedic surgery, and neurosurgery based on expertise, publications, research, diversity and field of practice. Evidence was reviewed, graded using the United States Preventive Services Task Force (USPSTF) criteria for evidence and recommendation strength and grade, and expert opinion was added to make consensus points for best practice. Results The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for LSS-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using USPSTF criteria and consensus points are presented. Discussion The algorithm for patient selection in the management of symptomatic spinal stenosis is evolving. Careful consideration of patient selection and anatomic architecture variance is critical for improved outcomes and patient safety. Conclusion ASPN created a guidance for best practice for minimally invasive surgical treatment of symptomatic spinal stenosis.

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“…On the other hand, the wide L5-S1 interlaminar space offers excellent working space for IA, and the former researches have achieved good clinical outcomes with the IA-PELD at L5-S1 level. [ 18 – 20 ]…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of transforaminal approach vs interlaminar approach in treating lumbar disc herniation

et al. 2020

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Background: Percutaneous endoscopic lumbar discectomy (PELD) has routinely performed in recent years for lumbar disc herniation because of the advances in technology of minimally invasive spine surgery. Two common operating routes for PELD have been introduced in the literature: transforaminal approach (TA) and interlaminar approach (IA). The purpose of our current retrospective clinical trial was to study whether the effect of IA-PELD is better than TA-PELD in the incidence of complications and clinical prognosis scores in the patients with L5-S1 lumbar disc herniation. Methods: Our present research was approved by the institutional review board in the Second Hospital of Nanjing. All the patients offered the informed consent. All the procedures containing human participants were conducted on the basis of the Helsinki Declaration. A retrospective analysis was implemented on 126 patients with L5-S1 disc herniated radiculopathy from March 2016 to March 2018, who were treated with the PELD utilizing the IA technique or the TA technique. Relevant data, such as the patients demographics, surgical duration, length of hospital stay, hospitalization expenses, complications were recorded. In our work, the outcomes of patients were determined at baseline, 6 months, 12 months, and 24 months after treatment. The measure of primary outcome was Oswestry Disability Index score. The other outcomes measured were Numeric Rating Scale pain scale, surgical duration, length of hospital stay, and complications. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied for the analysis of all the statistical data. When P value <.05, it was considered to be significant in statistics. Results: This protocol will provide a solid theoretical basis for exploring which PELD approach is better in treatment of lumbar disc herniation. Trial registration: This study protocol was registered in Research Registry (researchregistry5988).

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Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminarversusbilateral transforaminal approach

Cited by 16 publications

References 30 publications

Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

Clinical effects of transforaminal approach vs interlaminar approach in treating lumbar disc herniation

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