Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy
| Autor: | Zachary L McCormick, Jaymin Patel, Leda Ghannad, David J. Kennedy, Christopher T. Plastaras, Mary Caldwell, David R. Walega, Ashwin N. Babu, Samuel K. Chu, Christine M. Eng, Joel M. Press, Daniel M. Cushman, Steven Makovitch, Benjamin Marshall, Christina Marciniak |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Triamcinolone acetonide medicine.drug_class medicine.medical_treatment Injections Epidural Physical Therapy Sports Therapy and Rehabilitation Triamcinolone Betamethasone law.invention 03 medical and health sciences 0302 clinical medicine Lumbar Randomized controlled trial 030202 anesthesiology law medicine Humans Radiculopathy Aged Retrospective Studies Epidural steroid injection business.industry Rehabilitation Retrospective cohort study Middle Aged medicine.disease Surgery Treatment Outcome Neurology Radicular pain Anesthesia Corticosteroid Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | PM&R. 8:1039-1045 |
| ISSN: | 1934-1563 1934-1482 |
| DOI: | 10.1016/j.pmrj.2016.03.011 |
| Popis: | 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 ( 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. Level of Evidence III |
| Databáze: | OpenAIRE |
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