Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy

Abstract

III.

Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report

“…Bilir and Gulec22 reported CES after epidural injection using 60 mg triamcinolone diacetate. Triamcinolone, which was used in our study, can cause spinal cord infarction, which is a complication of intravascular injection to the radicular artery when using transforaminal ESI 27. It is considered safe, and no complications, such as spinal cord infarction or lumbosacral nerve-root injury, have been reported when using this particular steroid in CEI.…”

Recommended Dexamethasone Dose for Epidural Administration: Response to the Comments of Koetsier

“…McCormick et al 5 performed a retrospective comparison between particulate (triamcinolone 80 mg, betamethasone 12 mg) and nonparticulate (dexamethasone 15 mg) steroids in patients with electromyography-confirmed lumbosacral radiculopathy. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction at short-term follow up (<30 days).…”

“…McCormick et al . performed a retrospective comparison between particulate (triamcinolone 80 mg, betamethasone 12 mg) and nonparticulate (dexamethasone 15 mg) steroids in patients with electromyography‐confirmed lumbosacral radiculopathy.…”

Three Epidural Steroid Techniques

“…Admittedly, the literature supporting this approach largely includes particulate corticosteroid in the epidural injectate, which we now know poses a rare but catastrophic risk of spinal cord infarction if inadvertently introduced into a radiculomedullary artery (RMA; artery of Adamkiewicz) [8]. As such, the Multisociety Pain Workgroup recommended the use of non‐particulate corticosteroid during an initial lumbar TFESI in a 2015 safe‐use initiative consensus statement [9]. Although this practice shift was initially met by hesitation because of anecdotes of inferior effectiveness of dexamethasone compared with particulate corticosteroids, a growing body of evidence suggests no advantage or minimal advantage for pain and functional improvement associated with a lumbar TFESI with particulate corticosteroid vs dexamethasone [10,11].…”