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, 28 (1), 11-21

Comparison of the Efficacy of Caudal, Interlaminar, and Transforaminal Epidural Injections in Managing Lumbar Disc Herniation: Is One Method Superior to the Other?

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Comparison of the Efficacy of Caudal, Interlaminar, and Transforaminal Epidural Injections in Managing Lumbar Disc Herniation: Is One Method Superior to the Other?

Laxmaiah Manchikanti et al. Korean J Pain.

Abstract

Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches.

Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients).

Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial.

Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.

Keywords: Caudal epidural steroids; Disc herniation; Local anesthetic; Lumbar interlaminar steroids; Radiculitis; Transforaminal epidural steroids.

Figures

Fig. 1
Fig. 1
Illustration of average Numeric Rating Scale scores for pain at different follow-up points by type of epidural. *P value at different time intervals as compared with baseline (within group, pair-wise comparisons with Bonferroni correction) #1 P = 0.058, #2 P = 0.227, #3 P = 0.269, #4 P = 0.355, #5 P = 0.202, #6 P = 0.515 respectively, for between-group comparisons at specified time intervals with Bonferroni correction.
Fig. 2
Fig. 2
Illustration of average Oswestry Disability Index scores for function at different follow-up points by type of epidural. *P value at different time intervals as compared with baseline (within group, pair-wise comparisons with Bonferroni correction) #1 P = 0.052, #2 P = 0.652, #3 P = 0.951, #4 P = 0.896, #5 P = 0.963, #6 P = 0.925 respectively, for between-group comparisons at specified time intervals with Bonferroni correction.
Fig. 3
Fig. 3
Illustration of reduction (at least 50%) of Numeric Rating Scale scores for pain and Oswestry Disability Index scores for function from baseline (all patients).
Fig. 4
Fig. 4
Illustration of reduction (at least 50%) of Numeric Rating Scale scores for Pain and Oswestry Disability Index scores for function from baseline (only responsive patients).
Fig. 5
Fig. 5
Illustration of reduction (at least 50%) of Numeric Rating Scale scores for pain and Oswestry Disability Index scores for function from baseline (all patients).
Fig. 6
Fig. 6
Illustration of reduction (at least 50%) of Numeric Rating Scale scores for pain and Oswestry Disability Index scores for function from baseline (only responsive patients).

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References

    1. Birkmeyer NJ, Weinstein JN, Tosteson AN, Tosteson TD, Skinner JS, Lurie JD, et al. Design of the Spine Patient outcomes Research Trial (SPORT) Spine (Phila Pa 1976) 2002;27:1361–1372. - PMC - PubMed
    1. Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, et al. The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial. J Bone Joint Surg Am. 2012;94:1353–1358. - PMC - PubMed
    1. Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976) 2014;39:3–16. - PMC - PubMed
    1. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210–215.
    1. Manson NA, McKeon MD, Abraham EP. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series. Can J Surg. 2013;56:89–96. - PMC - PubMed

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