Intra-articular steroid injections for lumbar disk herniation: a systematic review and meta-analysis

Lumbar disc herniation (LDH) is one of the most common causes of lower back pain, radiculopathy, and functional impairment. Intra-articular (IA) steroid injections, including transforaminal (TFESI), interlaminar (IESI), and caudal (CESI) epidural steroid injections, are commonly administered to alleviate these symptoms when surgery is not indicated or opted for. This systematic review and meta-analysis evaluates the efficacy of these injection modalities in reducing pain and disability in LDH patients.

Following PRISMA, 19,664 studies on IA steroid injections for LDH were screened, yielding 41 eligible studies. Random-effects and fixed effects meta-analyses computed pooled standardized mean changes (SMC), depending on heterogeneity (I²).

TFESI showed strong short-term efficacy, with the greatest pooled NRS improvement of -5.15 (95% CI: -6.59, -3.72, p < 0.001, I² = 99.14%) at 3 months and the largest VAS reduction of -30.53 (95% CI: -43.89, -17.17, p < 0.001, I² = 99.99%) at 3 months. CESI had the highest ODI improvement at 1 month (-18.99, 95% CI: -26.88, -11.10, p < 0.001, I² = 99.35%), while IESI demonstrated the greatest ODI reduction at 6 months (-16.06, 95% CI: -16.83, -15.28, p < 0.001, I² = 18.85%).

This meta-analysis suggests that IA injections may relieve LDH symptoms, with TFESI showing the greatest pain relief and functional improvement. However, significant heterogeneity calls for standardized protocols and further research. Demographic factors minimally influenced outcomes, whereas methodological variability underscores treatment complexity. Future studies should emphasize methodological consistency and personalized approaches to optimize patient outcomes.