What is the efficacy of lumbar transforaminal epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

The following research demonstrated the efficacy of lumbar transforaminal epidural injections (see Approaches for Epidural Injections) in patients with persistent sciatica from lumbar disk herniation or spinal stenosis:

  • In 2002, Vad and colleagues reported a prospective randomized study comparing transforaminal lumbar epidural injection with lumbar paraspinal trigger-point injection. [2] They randomized 48 patients with sciatica from herniated disk pulposus (confirmed by lumbar spine MRI) into 2 groups. One group received transforaminal lumbar epidural injection, and the other received a lumbar paraspinal intramuscular injection with saline. The average follow-up period was 16 months. The authors used patient satisfaction, the Rolland-Morris scale, and pain reduction extent as indices for efficacy. The success rate in the transforaminal injection group was 84%, compared with 48% in the saline group.

  • Botwin and colleagues demonstrated the efficacy of the transforaminal epidural injection in their retrospective cohort study in patients with sciatica (caused by lumbar spinal stenosis). [3] Thirty-four patients who did not respond to nonsteroidal anti-inflammatory agents and oral analgesics received 1.9 injections (average). At 1 year, 75% of the patients had greater than 50% pain reduction, 64% improved their walking duration, and 57% increased their standing tolerance. An additional benefit of ESIs in many patients is that the injections can potentially obviate the need for hospitalization and surgery in many patients.

  • Riew and colleagues reported results from a prospective, randomized, double-blinded, controlled clinical trial on 55 patients with severe sciatica from spinal stenosis or lumbar disk herniations. [4] These patients had not responded to 6 weeks of conservative treatment and were considered to be surgical candidates. The patients were divided into 2 groups; 1 group received lumbar epidural injection with bupivacaine and steroid, while the other group received only bupivacaine. Up to 4 lumbar epidural injections were delivered if needed. The follow-up period was 2-3 years. The study demonstrated that only 23% of patients in the group that received lumbar ESIs needed surgery, while 67% of patients in the bupivacaine injection group underwent surgery. The difference was statistically significant.

  • A follow-up study at 5 years found that 17 (81%) of 21 patients surveyed still had still not opted for surgery. [5] This report demonstrated a benefit from lumbar ESIs in patients who had been diagnosed with lumbar spinal stenosis or herniated nucleus pulposus, with the injections helping to reduce the need for surgery.

  • A recent systemic review of 14 randomized and 10 nonrandomized studies on the efficacy of lumbar transforaminal epidural steroid injections for lumbar radicular pain was performed by Manchikanti L et al. [6] The results demonstrated that the efficacy is good for radiculitis secondary to disk herniation with local anesthetics and steroids and fair with local anesthetic only, efficacy is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids, and efficacy is limited for axial pain and postsurgery syndrome using local anesthetic with or without steroids.


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