Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial.

BACKGROUND: Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation. OBJECTIVE: This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation. DESIGN: A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain. All subjects received a single level transforaminal epidural steroid injection with either dexamethasone or triamcinolone. Repeat injections were allowed as determined by the blinded physician and subjects. Primary outcomes included: number of injections received, surgical rates, and categorical pain scores at 2 weeks, 3 months, and 6 months. Secondary outcomes included mean Oswestry Disability Index. RESULTS: Both triamcinolone and dexamethasone resulted in statically significant improvements in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The surgical rates were comparable with 14.6% of the dexamethasone group and 18.9% of the triamcinolone group receiving surgery. There was a statistically significant difference in the number of injections received, with 17.1% of the dexamethasone group receiving three injections vs only 2.7% of the triamcinolone group. CONCLUSIONS: Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation, and frequently only require 1 or 2 injections for symptomatic relief. Dexamethasone appears to possess reasonably similar effectiveness when compared with triamcinolone. However, the dexamethasone group received slightly more injections than the triamcinolone group to achieve the same outcomes.

The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography.

OBJECTIVE: To determine whether digital subtraction angiography (DSA) combined with real-time fluoroscopic imaging improves the detection rate of intravascular injection during cervical transforaminal epidural steroid injections (CTFESIs). DESIGN: Retrospective analysis. SETTING: Outpatient surgery center. PARTICIPANTS: A total of 134 subjects with cervical radicular pain who had CTFESIs performed by a single physician between June 9, 2004, and April 23, 2007. INTERVENTIONS: One hundred seventy-seven CTFESIs performed at one or more cervical spinal levels either unilaterally or bilaterally. Procedures performed before September 12, 2005, used fluoroscopic guidance with contrast injection and live imaging to identify intravascular injection. All procedures performed after September 12, 2005, also included DSA. MAIN OUTCOME MEASURES: Intravascular injection detected during CTFESIs with and without DSA. RESULTS: Intravascular injection was detected in 17.9% of CTFESIs performed without DSA. By adding DSA technology to the real-time fluoroscopic imaging procedure, the detection of vascular injection nearly doubled to 32.8%, which was statistically significant (P = .0471). CONCLUSIONS: The use of DSA improves the detection rate of intravascular injection during CTFESIs.