Zachary L McCormick1, Daniel Cushman2, Benjamin Marshall3, Mary Caldwell4, Jaymin Patel5, Leda Ghannad6, Christine Eng7, Steven Makovitch8, Ashwin Babu9, Samuel K Chu10, Christina Marciniak11, David R Walega12, Joel Press13, Christopher Plastaras14, David J Kennedy15. 1. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, 345 East Superior St, Chicago, IL 60605(∗). Electronic address: zmccormi@gmail.com. 2. Department of PM&R, University of Utah, Salt Lake City, UT(†). 3. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡). 4. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(¶). 5. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(§). 6. Department of Pediatrics, Northwestern University Lurie Children's Hospital, Chicago, IL(∗∗). 7. Department of PM&R, Harvard Medical School/Spaulding, Boston, MA(††). 8. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡‡). 9. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(¶¶). 10. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(§§). 11. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(∗∗∗). 12. Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, IL(†††). 13. Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡‡‡). 14. Department of PM&R, University of Pennsylvania, Philadelphia, PA(¶¶¶). 15. Department of Orthopaedics, Stanford University, Palo Alto, CA(§§§).
Abstract
BACKGROUND: The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. OBJECTIVE: To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy. DESIGN: Multicenter retrospective cohort study. SETTING: Two tertiary academic spine centers. PATIENTS: Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy. INTERVENTIONS: TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. RESULTS: Seventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P = .26). CONCLUSIONS: This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed. LEVEL OF EVIDENCE: III.
BACKGROUND: The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. OBJECTIVE: To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy. DESIGN: Multicenter retrospective cohort study. SETTING: Two tertiary academic spine centers. PATIENTS: Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy. INTERVENTIONS:TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. RESULTS: Seventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P = .26). CONCLUSIONS: This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed. LEVEL OF EVIDENCE: III.
Authors: Marek Tagowski; Zbigniew Lewandowski; Jürg Hodler; Thomas Spiegel; Gerhard W Goerres Journal: Eur Radiol Date: 2019-03-18 Impact factor: 5.315
Authors: Christoph A Stueckle; Benedikt Hackert; Sarah Talarczyk; Martin Wawro; Patrick Haage; Ulrich Weger Journal: BMC Med Imaging Date: 2021-01-13 Impact factor: 1.930