The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data.

OBJECTIVE To determine the effectiveness of lumbar transforaminal injection of steroids in the treatment of radicular pain. DESIGN Comprehensive review of the literature with systematic analysis of all published data. INTERVENTIONS Four reviewers independently assessed 39 publications on the effectiveness of lumbar transforaminal injection of steroids. Each reviewer determined if a publication provided any valid information on effectiveness. Assessments were compared, and the data of each publication were evaluated in terms of the rigor with which they were produced and the evidence they provided of effectiveness. OUTCOME MEASURES The primary outcome sought was the success rate for relief of pain. Improvement in secondary outcomes was noted if reported. RESULTS For miscellaneous conditions, the available evidence is limited and is neither compelling nor conclusive. For disc herniation, the evidence is sufficiently abundant to show that lumbar transforaminal injection of steroids is not universally effective but, nevertheless, benefits a substantial proportion of patients, and is not a placebo. Success rates are higher in patients with contained herniations that cause only low-grade compression of the nerve. CONCLUSION In a substantial proportion of patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery. The evidence supporting this conclusion was revealed by comprehensive review of all published data and found to be much more compelling than it would have been if the literature review had been of the limited scope of a traditional "systematic review" of randomized, controlled trials only.