Epidural Steroids for Treating “Failed Back Surgery Syndrome”: Is Fluoroscopy Really Necessary?

Fredman, Brian; NUN, MEIR BEN; Zohar, Edna; IRAQI, GHUSAN; Shapiro, Myra; Gepstein, Reuven; Jedeikin, Robert

doi:10.1097/00132586-200006000-00047

Cited by 62 publications

(89 citation statements)

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“…However, the risks are low and considering the less expensive nature of the procedure compared with surgical interventions, transforaminal epidural injections with or without steroids appear to be cost effective [17,31]. Furthermore, transforaminal epidural injections are always performed under fluoroscopy with (out) contrast injection [44][45][46][47][48], and thus chances of inaccurate needle placement minimised.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Quraishi

2011

Eur Spine J

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Background Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection. Study designHence, this study aims to assess the effectiveness of steroid injection to treat lumbar radicular pain using a meta-analysis of transforaminal epidural injection therapy for low back and lumbar radicular pain. The comparison was based on the mean difference in the Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) from baseline to the specified followed up. Methods The available literature of lumbar transforaminal epidural injections in managing low back and radicular pain was reviewed. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to 2009, and manual searches of the bibliographies of known primary and review articles. Finally, the search included the Current Controlled Trials Register and the Cochrane Database of Controlled Trials. Results The initial search identified 126 papers. After screening, five randomised controlled trials (RCTs) were studied for analysis and only three of these had followedup patients systematically with pain and disability outcome scores to 3 months and of these, only one had follow up to 12 months. A total of 187 patients ('treatment group' receiving local anaesthetic/steroid injection) were compared with 181 patients ('control' group, receiving local anaesthetic only or saline injection). Improvement in pain (standardised mean difference in VAS 0.2 in favour of 'treatment'; 95%CI: -0.41 to 0.00, p = 0.05, I squared 0%) but not disability (standardised mean difference in ODI 0; 95%CI: -0.21 to 0.20, p = 0.99, I squared 0%) was observed between 'treatment' and 'control' groups; these differences were not significant. Additionally, the one study following patients to 12 months did not find any significant difference in VAS and ODI between treatment and control groups. ConclusionThe current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature.

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Section: Discussionmentioning

confidence: 99%

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Quraishi

2011

Eur Spine J

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“…Anonymous treatments had been attempted by pain physicians to find the solution for reducing this complicated pain condition. Epidural steroids 11,12) , spinal cord stimulation 13) , opioids 14) , acupuncture 15) , and exercises 16) have been reported to be " rather effective treatment" for FBSS; however, the success of such treatments has not been clearly established.…”

Section: Discussionmentioning

confidence: 99%

SPINAL EPIDUROSCOPIC EPIDUROPLASTY (SEE) effectively improved symptoms in patients with failed back surgery syndrome: 3 cases

et al. 2002

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“…Accurate placement of the epidural catheter can be difficult. The necessity of fluoroscopic guidance was addressed by Fredman et al [62]. In this study, 50 patients were checked for placement of the catheter tip.…”

Section: Epidural Steroid Injectionmentioning

confidence: 97%

A rationale for the treatment algorithm of failed back surgery syndrome

Anderson

2000

Current Review of Pain

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Epidural Steroids for Treating “Failed Back Surgery Syndrome”: Is Fluoroscopy Really Necessary?

Cited by 62 publications

References 0 publications

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

SPINAL EPIDUROSCOPIC EPIDUROPLASTY (SEE) effectively improved symptoms in patients with failed back surgery syndrome: 3 cases

A rationale for the treatment algorithm of failed back surgery syndrome

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