Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy. Issue 11 (6th April 2016) - McCormick, Zachary L.
Abstract: Background: The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature. Objective: To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)‐confirmed lumbosacral radiculopathy. Design: Multicenter retrospective cohort study. Setting: Two tertiary academic spine centers. Patients: Consecutive patients, aged 18 years or older, with EMG‐confirmed lumbosacral radiculopathy. Interventions: TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG. Main Outcome Measures: The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short‐term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid. Results: Seventy‐eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty‐one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short‐term follow‐up (35%; 95% confidence interval [CI], 21‐51 versus 28%; 95% CI, 13‐43) or at intermediate follow‐up (40%; 95% CI, 21‐59 versus 39%; 95% CI, 19‐59). There was no difference in the mean number of injections administered between groups at intermediate follow‐up ( P = .26). Conclusions: This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG‐confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first‐line therapy, although confirmation with a randomized study is needed. Level of Evidence: III