Particulate vs Non-Particulate Steroids for Transforaminal Epidural Steroid Injections: Systematic Review and Meta-analysis of the Current Literature.

BACKGROUND The efficacy of particulate and non-particulate steroids in patients receiving epidural steroid injections remains unclear. OBJECTIVE The purpose of this meta-analysis was to compare the efficacy of particulate and non-particulate steroids in patients receiving epidural injections for radicular pain over 3 months. STUDY DESIGN Systematic review and meta-analysis. METHODS We reviewed PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar, and Directory of open access journals for trials that compared efficacy of particulate steroid with non-particulate. A meta-analysis was performed on treatment related to mean change in visual analogue score (VAS) between the particulate and non-particulate steroids. Two authors independently reviewed the data for inclusion. RESULTS Seven studies comprising 3,542 patients in the particulate group and 856 patients in the non-particulate group were included. Pooled mean maximum change of VAS was higher by 0.53 (95% CI: 0.14 to 0.92; P = 0.007; I2 = 50.2%) in the particulate group compared to the non-particulate group. The non-particulate group had a larger proportion of patients with more than 50% pain relief than the particulate group [OR 0.81 (95% CI: 0.68 to 0.97, P = 0.024). LIMITATIONS Limited number of trials that fit the inclusion criteria and were available for analysis. CONCLUSIONS As the use of particulate steroids seems to be associated with slightly better VAS scores only, clinicians need to weigh their clinical relevance in the light of complications and recent FDA recommendations on the use of particulate steroids.