Bhargava, Amit a; DePalma, Michael J c; Ludwig, Steven b; Gelb, Daniel b; Slipman, Curtis W d
Purpose of review: To review critically the available trials investigating the utility of epidural steroid injections to treat lumbosacral radiculopathy.
Recent findings: A medical literature search was conducted using MEDLINE, OVID, PubMed, EMBASE, and MDConsult for articles published from 1 December 2003 to January 2005 that incorporated the key words epidural, lumbar, transforaminal, caudal, selective nerve root blocks, spinal, injections, and radiculopathy separately or in combination. Subsequently, the studies were divided into interlaminar, caudal, and transforaminal epidural injections. We included all publications, whether a full article or an abstract, on the utility of epidural steroid injections to treat lumbosacral radiculopathy. Data were compiled for each of the following categories: documentation of technique, number of patients, outcome measures, follow-up intervals, and results and reported complications. The minimal volume of contrast dye (0.5-2.0 ml) is required to reach the anterior epidural space by transforaminal epidural injections. Our analysis found that all approaches to the interlaminar, caudal, and transforaminal epidural space provide long-term relief in 27-56% patients.
Summary: Although conclusive evidence is lacking, epidural space steroid instillation via the transforaminal.
Current Opinion in Orthopedics. 16(3):152-157, June 2005.