The article is a systematic review and meta-analysis that evaluates the effectiveness of different types of epidural injections (transforaminal, interlaminar, and caudal) in reducing pain and improving function in patients with herniated lumbar disc. The study included 11 studies comprising 1,050 patients. The results showed that transforaminal epidural injection (TFEI) had the highest probability of being the most effective technique in reducing pain and improving function in the short- and long-term evaluation periods. However, the analysis was limited by the small number of previous studies included and the inability to conduct subgroup analysis. The authors recommend further qualified trials to derive definitive conclusions. The keywords associated with the article include back pain, caudal injection, epidural injection, interlaminar injection, lumbar spine, radicular pain, transforaminal injection, and disc herniation
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest spine hospital in London
Published article
CONCLUSIONS: TFEI had the best potential of the 3 EI techniques to reduce pain and improve function in patients with a herniated lumbar disc. Further qualified trials comparing the effects of these 3 techniques are warranted to derive definitive conclusions.
Spine Epidural Lumbar Caudal transforaminal Expert. Best Spinal Surgeon UK
Abstract Background: Epidural injection (EI) has been used to manage lower back and radicular leg pain caused by a herniated lumbar disc. There are 3 types of EI techniques currently being used: transforaminal (TFEI), interlaminar (ILEI), and caudal epidural injections (CEI). Objectives: To evaluate the comparative effectiveness of TFEI, ILEI, and CEI in reducing pain,
Abstract
Background: Epidural injection (EI) has been used to manage lower back and radicular leg pain caused by a herniated lumbar disc. There are 3 types of EI techniques currently being used: transforaminal (TFEI), interlaminar (ILEI), and caudal epidural injections (CEI).
Objectives: To evaluate the comparative effectiveness of TFEI, ILEI, and CEI in reducing pain and improving function in patients with HLD.
Study design: Systematic review and meta-analysis.
Methods: The PubMed, Embase, Cochrane Library, and Scopus databases were searched from the earliest records up to August 2022 for randomized controlled trials (RCTs) and non-RCTs. The standard mean differences (SMDs) in the changes in the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were calculated from one week through one month posttreatment (short-term) and from 4 months through 6 months posttreatment (long-term).
Results: In total, 11 studies comprising 1,050 patients were included. Network meta-analysis showed that the improvement in the VAS scores was better with TFEI than with CEI (SMD = -1.16, 95% CI = -2.10 to -0.23). Ranking probability analysis showed that TFEI had the highest probability of being the best treatment for reducing pain and improving function in the short- and long-term evaluation periods.
Limitations: Only a small number of previous studies were included in our analysis. Also, subgroup analysis according to the injection volume, material type, or pain onset could not be conducted.
Conclusions: TFEI had the best potential of the 3 EI techniques to reduce pain and improve function in patients with a herniated lumbar disc. Further qualified trials comparing the effects of these 3 techniques are warranted to derive definitive conclusions.
Keywords: back pain; caudal injection; epidural injection; interlaminar injection; lumbar spine; radicular pain; transforaminal injection; Disc herniation.
The London Spine Unit : finest spine hospital in London
Read the original publication:
Effectiveness of Transforaminal, Interlaminar, and Caudal Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Network Meta-analysis
