A systematic review of the effectiveness of CT-guided, lumbar transforaminal injection of steroids.

Abstract

OBJECTIVE:

To determine the effectiveness and safety of computerized tomography (CT) guided, lumbar transforaminal injection of steroids in the treatment of radicular pain.

DESIGN:

Systematic review of published literature.

INTERVENTIONS:

Two reviewers independently assessed 19 publications on the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids.

OUTCOME MEASURES:

For effectiveness, the primary outcome was the success rate for relief of pain. For safety, the radiation exposure involved and the nature of complications were determined.

RESULTS:

Much of the literature fails to provide evidence. Two studies reported decreases in mean or median pain scores but no other data. Two studies reported success rates of between 34% and 62% for achieving 50% relief of pain at between 1 and 6 months after treatment. CT-guided injections may involve greater radiation exposure than does fluoroscopy-guided injections and do not avoid catastrophic spinal cord injury.

CONCLUSION:

The evidence-base for CT-guided lumbar transforaminal injection of steroids is meagre. This intervention is not more effective than fluoroscopy-guided injections and is not demonstrably safer.

• Authors: John Bui, Nikolai Bogduk
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 14 Issue 12 Pg. 1860-5 (Dec 2013) ISSN: 1526-4637 [Electronic] England
• PMID: 24330228 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Wiley Periodicals, Inc.

Chemical References

• Steroids

Topics

• Humans
• Injections, Epidural (methods)
• Lumbosacral Region
• Radiculopathy (drug therapy)
• Steroids (administration & dosage)
• Surgery, Computer-Assisted
• Tomography, X-Ray Computed