Lumbar Epidural Injections: Review of Efficacy and Discussion of Practice Options
نویسندگان
چکیده
Background: In the United States, low back pain remains a common problem and a number one reason to see a physician in the outpatient setting. Etiology is complex and likely multifactorial and includes; degenerative disc disease, zygapophysial joint arthritis, vertebral misalignment, muscle strain, ligament sprain, myofascial pain, among others. Based on evidence of increased inflammatory response in disc herniation and degenerative discs, epidural steroid injections (ESI) have been used to treat lumbosacral radicular pain. Objective: To focus on the appropriate use of lumbar ESI in treating lumbosacral radicular pain in the United States, comparing and contrasting transforaminal, interlaminar, and caudal approaches for steroid delivery, as well as a comparison of commonly used steroid preparations. Methods: PubMED, MEDLINE, and OVID databases were reviewed utilizing the following subject headings: low back pain, epidural steroid injections, transforaminal epidural steroid injections (TFESI), interlaminar epidural steroid injections (ILESI), and caudal epidural steroid injections (CESI) dated from 2000 to 2014. The bibliographies of major articles and reviews were also cross-referenced for additional sources. Results: A number of articles that included randomized control trials, comprehensive and systematic reviews, and meta-analyses were found. These provided a broad, detailed overview of the subject, that we used to explore the data surrounding use of ESI for treatment of lumbosacral radicular pain. Conclusions: Most agree that the evidence for epidural steroid injection efficacy is strongest for short term relief of lumbosacral radicular pain. Most of the systemic reviews have agreed that the strongest evidence for TFESI use is for relief of unilateral lumbosacral radicular pain. The evidence suggests using ILESI in patients with bilateral and/ or multi-level lumbosacral radicular pain. The data correlates efficacy of CESI in low level bilateral or multilevel lumbosacral radicular pain as well as in patients with history of lumbar surgery.
منابع مشابه
Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review
CONTEXT Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. EVIDENCE ACQUISITION Recent randomized trials, systematic reviews ...
متن کاملEfficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis.
BACKGROUND Epidural injections have been used since 1901 in managing low back pain and sciatica. Spinal pain, disability, health, and economic impact continue to increase, despite numerous modalities of interventions available in managing chronic spinal pain. Thus far, systematic reviews performed to assess the efficacy of epidural injections in managing chronic spinal pain have yielded conflic...
متن کاملWhat is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion
BACKGROUND Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to deter...
متن کاملComparison the effect of epidural steroid injection by Caudal and Lumbar methods for controlling the radicular pain of lower extremity
Aims and background: Chronic low back pain is one of the common causes of patients referring to specialized and general medical clinics. The positive effect of Epidural Steroid injection has been proven in relieving pain in these patients. In this study, the epidural effects of methylprednisolone acetate in these two methods of Caudal and Lumbar were compared. Materials and Methods: In thi...
متن کاملEfficacy of Percutaneous Adhesiolysis in the Treatment of Lumbar Post Surgery Syndrome
CONTEXT Lumbar post-surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis is often contemplated in managing lumbar post surgery syndrome. Recent guidelines and...
متن کامل