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Intra-articular steroid injections for lumbar disk herniation: a systematic review and meta-analysis
Saran Singh Gill1,2, Pratik Ramkumar3,4, Abith Ganesh Kamath3,4
1Imperial College London, London, UK. saran.gill21@imperial.ac.uk.
Acta Neurochirurgica
|November 13, 2025
Summary
Intra-articular (IA) steroid injections effectively alleviate pain and disability from lumbar disc herniation (LDH). Transforaminal epidural steroid injections (TFESI) offer the most significant short-term pain relief and functional improvement for LDH patients.
Area of Science:
- Pain Management
- Neurosurgery
- Musculoskeletal Disorders
Background:
- Lumbar disc herniation (LDH) is a leading cause of lower back pain and functional impairment.
- Intra-articular (IA) steroid injections, including transforaminal (TFESI), interlaminar (IESI), and caudal (CESI) epidural steroid injections, are common non-surgical treatments for LDH.
- Evaluating the comparative efficacy of these IA injection modalities is crucial for optimizing patient care.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of IA steroid injections in reducing pain and disability in patients with LDH.
- To compare the effectiveness of TFESI, IESI, and CESI for symptom management in LDH.
Main Methods:
- A systematic review and meta-analysis following PRISMA guidelines.
- Screening of 19,664 studies, with 41 eligible studies included.
- Application of random-effects and fixed effects meta-analyses to compute pooled standardized mean changes (SMC).
Main Results:
- Transforaminal epidural steroid injections (TFESI) demonstrated strong short-term efficacy, with significant improvement in pain scores (NRS: -5.15, VAS: -30.53) at 3 months.
- Caudal epidural steroid injections (CESI) showed the highest improvement in Oswestry Disability Index (ODI) at 1 month (-18.99).
- Interlaminar epidural steroid injections (IESI) provided the greatest ODI reduction at 6 months (-16.06).
Conclusions:
- IA steroid injections can provide symptom relief for LDH, with TFESI showing the most substantial pain relief and functional improvement.
- Significant heterogeneity among studies necessitates standardized protocols and further research.
- Methodological variability highlights the complexity of IA injection treatments, suggesting a need for personalized approaches in future studies.
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