A systematic review and network meta-analysis comparing different epidural steroid injection approaches

Area of Science:

• Pain Management
• Neurosurgery
• Interventional Radiology

Background:

• Low back pain (LBP) and lumbosacral radiculopathy are prevalent conditions causing nerve root injury and varied neurological deficits.
• Epidural steroid injections are a common treatment modality for these debilitating conditions.

Approach:

• A systematic review and network meta-analysis was conducted to evaluate the efficacy of different epidural injection techniques.
• Electronic databases (PubMed, Scopus, Web of Science, Cochrane, Embase) were searched for relevant randomized controlled trials, cohort studies, and case-control studies.
• Studies included adult patients (≥30 years) with LBP and radicular pain undergoing epidural steroid injections via various methods.

Key Points:

• For short-term pain reduction (VAS 0-10), parasagittal intralaminar (PIL) injections were most effective (MD = -1.16).
• Transforaminal (TF) injections demonstrated the greatest long-term effectiveness in reducing pain (VAS 0-10 and VAS 0-100) and improving the Oswestry Disability Index (ODI).
• Short-term VAS (0-100) showed no significant difference among injection techniques, but TF was superior for long-term outcomes.

Conclusions:

• Transforaminal (TF) epidural steroid injections represent the most effective approach for achieving sustained pain relief and functional improvement in patients with LBP and radiculopathy.
• Both PIL and TF techniques provide significant short-term benefits, highlighting their utility in acute pain management.
• Limitations include heterogeneity and risk of bias in some analyzed studies, necessitating cautious interpretation of findings.