A Comparative Systematic Review and Meta-Analysis of 3 Routes of Administration of Epidural Injections in Lumbar Disc Herniation

BACKGROUND: The Best Practices in Pain Management from the U.S. Department of Health and Human Services (HHS) describes interventional techniques as part a continuum. Epidural injections are commonly utilized modalities managing low back lower extremity pain. were initially administered 1901 where first descriptions caudal epidural with local anesthetic for pain appeared. Since then, multiple developments have occurred. Currently, provided by caudal, interlaminar, transforaminal approaches. comparative effectiveness each modality has been studied. However, assessment sparse. OBJECTIVES: To assess efficacy 3 routes administration lumbar disc herniation. STUDY DESIGN: A systematic review meta-analysis randomized controlled trials (RCTs) transforaminal, interlaminar chronic due to METHODS: RCTs placebo control or an active design, performed under fluoroscopic guidance, at least 6 months follow-up included. outcome measures relief functional status improvement. Significant improvement was defined 50% greater Data extraction methodological quality performed. Evidence summarized utilizing principles best evidence synthesis. RESULTS: total 21 Of these, 7 studied injections, whereas 12 trials, 10 which all met inclusion criteria. Based on qualitative quantitative analysis, included conventional dual-arm single-arm analysis approach space, there is Level I steroids, II alone approaches, steroids short- long-term relief. LIMITATIONS: There paucity literature intermediate appropriate parameters. Conventional feasible only injections. CONCLUSION: showed demonstrated. In contrast, alone. KEY WORDS: Chronic pain, radiculopathy, herniation, sciatica, anesthetic,