The Effectiveness of Lumbar Transforaminal Injection of Steroids: A Comprehensive Review with Systematic Analysis of the Published Data

Abstract

In a substantial proportion of patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery. The evidence supporting this conclusion was revealed by comprehensive review of all published data and found to be much more compelling than it would have been if the literature review had been of the limited scope of a traditional "systematic review" of randomized, controlled trials only.

Three week results of transforaminal epidural steroid injection in patients with chronic unilateral low back related leg pain: The relation to MRI findings and clinical features

“…In subjects with chronic low back related leg pain, a group with an expected response rate lower than for those with acute symptoms [2,32], we found a definite treatment response rate after 3 weeks of approximately 25%. However, our aim was not to evaluate treatment effect but to compare sub-group differences.…”

“…Then a stepwise multiple logistic regression was performed for all explanatory variables (BL characteristics [ Table 1], BL values of primary and secondary outcomes and for the results from 30 min-post-TESI assessments [ Table 2]) that were significantly related to the dependent variables (p < 0.05). Two dichotomous dependent variables were constructed of the two primary outcomes after 3 weeks according to previously published cutoff points (definite treatment response, VAS leg pain 50% reduction of pain and ODI 10 points reduction of disability; non-definite improvement, VAS leg pain 1-49% reduction and ODI 1-9 points reduction; negative response, VAS leg pain 0% reduction and ODI 0 points reduction) [2,15,31]. The definite treatment response results and the negative results constructed the dichotomous dependent variables and non-definite Relationship between VAS leg pain at baseline (BL) and at the 3-week follow-up and the respective relationship for ODI.…”

“…The treatment success rate for TESI was reported to be between 35-75% with the highest rates for subjects with acute symptoms [2]. For these subjects, foraminal DH [10], low-grade nerve compression [11] and neurologic deficit predicted treatment success in three reports [12] but failed to predict outcome in other reports [10,11,13].…”

“…For these subjects, foraminal DH [10], low-grade nerve compression [11] and neurologic deficit predicted treatment success in three reports [12] but failed to predict outcome in other reports [10,11,13]. For subjects with chronic symptoms the response rate was reported as significantly lower [2] and for those subjects, MRI verified DH at any location in contrast to non-discogenic foraminal nerve compression predicted favorable response to TESI [14]. These conflicting results may be due to the fact that MRI and neurologic examination fail to assess pain or low-grade inflammation and thus, additional tests (such as neurodynamic tests or an additional clinical assessment immediately post TESI) may play an important role in predicting the outcome of TESI.…”

“…Effectiveness of TESI in reducing leg pain has been determined with a maximum effect within one month after injection and then a gradual deterioration of outcome [2]. The ra-tion to disc material and thus, a positive neurodynamic test might predict favorable outcome to an antiinflammatory treatment such as TESI.…”