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Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation.

ABSTRACT: Prospective study.We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation.To our knowledge, there is no previous report of such a comparison in these patients.The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection.The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods.In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences.

SUBMITTER: Karamouzian S

PROVIDER: S-EPMC4206815 | biostudies-other | 2014 Oct

REPOSITORIES: biostudies-other

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Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation.

Karamouzian Saeid S Ebrahimi-Nejad Ali A Shahsavarani Shahram S Keikhosravi Ehsan E Shahba Mohsen M Ebrahimi Farzaneh F

Asian spine journal 20141018 5

<h4>Study design</h4>Prospective study.<h4>Purpose</h4>We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation.<h4>Overview of literature</h4>To our knowledge, there is no previous report of such a comparison in these patients.<h4>Methods</h4>The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and e ...[more]

PMID: 25346818

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Project description:As part of a comprehensive nonsurgical approach, epidural injections often are used in the management of lumbar disc herniation. Recent guidelines and systematic reviews have reached different conclusions about the efficacy of epidural injections in managing lumbar disc herniation.In this systematic review, we determined the efficacy (pain relief and functional improvement) of the three anatomic approaches (caudal, lumbar interlaminar, and transforaminal) for epidural injections in the treatment of disc herniation.We performed a literature search from 1966 to June 2013 in PubMed, Cochrane library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references for trials studying all types of epidural injections in managing chronic or chronic and subacute lumbar disc herniation. We wanted only randomized controlled trials (RCTs) (either placebo or active controlled) to be included in our analysis, and 66 studies found in our search fulfilled these criteria. We then assessed the methodologic quality of these 66 studies using the Cochrane review criteria for RCTs. Thirty-nine studies were excluded, leaving 23 RCTs of high and moderate methodologic quality for analysis. Evidence for the efficacy of all three approaches for epidural injection under fluoroscopy was strong for short-term (< 6 months) and moderate for long-term (? 6 months) based on the Cochrane rating system with five levels of evidence (best evidence synthesis), with strong evidence denoting consistent findings among multiple high-quality RCTs and moderate evidence denoting consistent findings among multiple low-quality RCTs or one high-quality RCT. The primary outcome measure was pain relief, defined as at least 50% improvement in pain or 3-point improvement in pain scores in at least 50% of the patients. The secondary outcome measure was functional improvement, defined as 50% reduction in disability or 30% reduction in the disability scores.Based on strong evidence for short-term efficacy from multiple high-quality trials and moderate evidence for long-term efficacy from at least one high quality trial, we found that fluoroscopic caudal, lumbar interlaminar, and transforaminal epidural injections were efficacious at managing lumbar disc herniation in terms of pain relief and functional improvement.The available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation.

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Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation.

Publications

Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation.

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