TY - JOUR
T1 - Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy
AU - McCormick, Zachary L.
AU - Cushman, Daniel
AU - Marshall, Benjamin
AU - Caldwell, Mary
AU - Patel, Jaymin
AU - Ghannad, Leda
AU - Eng, Christine
AU - Makovitch, Steven
AU - Babu, Ashwin
AU - Chu, Samuel K.
AU - Marciniak, Christina
AU - Walega, David R.
AU - Press, Joel
AU - Plastaras, Christopher
AU - Kennedy, David J.
N1 - Publisher Copyright:
© 2016 American Academy of Physical Medicine and Rehabilitation
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. Objective To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy. Design Multicenter retrospective cohort study. Setting Two tertiary academic spine centers. Patients Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy. Interventions TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. Main Outcome Measures The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. Results Seventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P =.26). Conclusions This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed.
AB - Background The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. Objective To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy. Design Multicenter retrospective cohort study. Setting Two tertiary academic spine centers. Patients Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy. Interventions TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. Main Outcome Measures The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. Results Seventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P =.26). Conclusions This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed.
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U2 - 10.1016/j.pmrj.2016.03.011
DO - 10.1016/j.pmrj.2016.03.011
M3 - Article
C2 - 27060648
AN - SCOPUS:84963701924
SN - 1934-1482
VL - 8
SP - 1039
EP - 1045
JO - PM and R
JF - PM and R
IS - 11
ER -