Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis
Epidural steroid injection has been used to treat back or radicular pain from lumbar and lumbosacral disc herniation (LDH). However, the superiority of transforaminal injection (TFESI) to caudal injection (CESI) remains controversial. This systematic review and meta-analysis aimed to investigate whe...
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Veröffentlicht in: | The spine journal 2018-12, Vol.18 (12), p.2343-2353 |
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description | Epidural steroid injection has been used to treat back or radicular pain from lumbar and lumbosacral disc herniation (LDH). However, the superiority of transforaminal injection (TFESI) to caudal injection (CESI) remains controversial.
This systematic review and meta-analysis aimed to investigate whether TFESI was more useful than CESI for achieving clinical outcomes in patients with LDH.
A systematic review and/or is not appropriate. A systematic review and meta-analysis. Spine hospital and tertiary care hospital.
Articles were chosen that compared the clinical efficacy of TFESI and CESI for treatment of low back and radicular leg pain caused by LDH.
Visual analogue scale, numeric rating scale, and Oswestry disability index.
A literature search was performed using MEDLINE, EMBASE, Cochrane review, and KoreaMed databases for studies published until July 2017. After reviewing titles, abstracts, and full-texts of 6,711 studies after initial database search, six studies were included in a qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from four studies and were analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the grading of recommendations assessment, development and evaluation methodology.
Among six studies, four articles supported the superiority of TFESI to CESI, one article showed no significant difference, and one article supported the superiority of CESI to TFESI. To obtain compatible or superior clinical results to TFESI, CESI might need to inject a larger amount of medication than was usually used. A meta-analysis showed short-term and long-term trends toward better clinical efficacy with TFESI than with CESI without statistical significance. The evidence level was low because of inconsistency and imprecision.
Comprehensive reviews of selected articles revealed better clinical benefits with TFESI than with CESI, possibly because TFESI had the ability to deliver medication directly into the target area. Because of a low level of evidence and no significant results on meta-analysis, TFESI could be weakly recommended over CESI. |
doi_str_mv | 10.1016/j.spinee.2018.06.720 |
format | Article |
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This systematic review and meta-analysis aimed to investigate whether TFESI was more useful than CESI for achieving clinical outcomes in patients with LDH.
A systematic review and/or is not appropriate. A systematic review and meta-analysis. Spine hospital and tertiary care hospital.
Articles were chosen that compared the clinical efficacy of TFESI and CESI for treatment of low back and radicular leg pain caused by LDH.
Visual analogue scale, numeric rating scale, and Oswestry disability index.
A literature search was performed using MEDLINE, EMBASE, Cochrane review, and KoreaMed databases for studies published until July 2017. After reviewing titles, abstracts, and full-texts of 6,711 studies after initial database search, six studies were included in a qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from four studies and were analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the grading of recommendations assessment, development and evaluation methodology.
Among six studies, four articles supported the superiority of TFESI to CESI, one article showed no significant difference, and one article supported the superiority of CESI to TFESI. To obtain compatible or superior clinical results to TFESI, CESI might need to inject a larger amount of medication than was usually used. A meta-analysis showed short-term and long-term trends toward better clinical efficacy with TFESI than with CESI without statistical significance. The evidence level was low because of inconsistency and imprecision.
Comprehensive reviews of selected articles revealed better clinical benefits with TFESI than with CESI, possibly because TFESI had the ability to deliver medication directly into the target area. Because of a low level of evidence and no significant results on meta-analysis, TFESI could be weakly recommended over CESI.</description><identifier>ISSN: 1529-9430</identifier><identifier>EISSN: 1878-1632</identifier><identifier>DOI: 10.1016/j.spinee.2018.06.720</identifier><identifier>PMID: 30030083</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anesthesia, Caudal - methods ; Anesthesia, Epidural - adverse effects ; Caudal ; Disc herniation ; Epidural steroid injection ; Humans ; Injections, Epidural - methods ; Intervertebral Disc Displacement - drug therapy ; Low Back Pain - drug therapy ; Lumbosacral Region ; Meta-analysis ; Pain Management - methods ; Steroids - administration & dosage ; Systemic review ; Transforaminal</subject><ispartof>The spine journal, 2018-12, Vol.18 (12), p.2343-2353</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-64dd7ab1d29adf19d79a4e7f83b9793b52513c8681ffd3c999b451f14671f3f03</citedby><cites>FETCH-LOGICAL-c362t-64dd7ab1d29adf19d79a4e7f83b9793b52513c8681ffd3c999b451f14671f3f03</cites><orcidid>0000-0003-2680-6953</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.spinee.2018.06.720$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30030083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Jung Hwan</creatorcontrib><creatorcontrib>Shin, Kyoung-ho</creatorcontrib><creatorcontrib>Bahk, Sung Jin</creatorcontrib><creatorcontrib>Lee, Goo Joo</creatorcontrib><creatorcontrib>Kim, Dong Hwan</creatorcontrib><creatorcontrib>Lee, Chang-Hyung</creatorcontrib><creatorcontrib>Kim, Du Hwan</creatorcontrib><creatorcontrib>Yang, Hee Seung</creatorcontrib><creatorcontrib>Lee, Sang-Ho</creatorcontrib><title>Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis</title><title>The spine journal</title><addtitle>Spine J</addtitle><description>Epidural steroid injection has been used to treat back or radicular pain from lumbar and lumbosacral disc herniation (LDH). However, the superiority of transforaminal injection (TFESI) to caudal injection (CESI) remains controversial.
This systematic review and meta-analysis aimed to investigate whether TFESI was more useful than CESI for achieving clinical outcomes in patients with LDH.
A systematic review and/or is not appropriate. A systematic review and meta-analysis. Spine hospital and tertiary care hospital.
Articles were chosen that compared the clinical efficacy of TFESI and CESI for treatment of low back and radicular leg pain caused by LDH.
Visual analogue scale, numeric rating scale, and Oswestry disability index.
A literature search was performed using MEDLINE, EMBASE, Cochrane review, and KoreaMed databases for studies published until July 2017. After reviewing titles, abstracts, and full-texts of 6,711 studies after initial database search, six studies were included in a qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from four studies and were analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the grading of recommendations assessment, development and evaluation methodology.
Among six studies, four articles supported the superiority of TFESI to CESI, one article showed no significant difference, and one article supported the superiority of CESI to TFESI. To obtain compatible or superior clinical results to TFESI, CESI might need to inject a larger amount of medication than was usually used. A meta-analysis showed short-term and long-term trends toward better clinical efficacy with TFESI than with CESI without statistical significance. The evidence level was low because of inconsistency and imprecision.
Comprehensive reviews of selected articles revealed better clinical benefits with TFESI than with CESI, possibly because TFESI had the ability to deliver medication directly into the target area. Because of a low level of evidence and no significant results on meta-analysis, TFESI could be weakly recommended over CESI.</description><subject>Anesthesia, Caudal - methods</subject><subject>Anesthesia, Epidural - adverse effects</subject><subject>Caudal</subject><subject>Disc herniation</subject><subject>Epidural steroid injection</subject><subject>Humans</subject><subject>Injections, Epidural - methods</subject><subject>Intervertebral Disc Displacement - drug therapy</subject><subject>Low Back Pain - drug therapy</subject><subject>Lumbosacral Region</subject><subject>Meta-analysis</subject><subject>Pain Management - methods</subject><subject>Steroids - administration & dosage</subject><subject>Systemic review</subject><subject>Transforaminal</subject><issn>1529-9430</issn><issn>1878-1632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuOFSEQhonROOPoGxjD0k23XPpwcWEyOfGWTOJG14SGInLSDS10a84b-ZjSc0aXJiRVwPdXQf0IvaSkp4SKN6e-LjEB9IxQ1RPRS0YeoWuqpOqo4Oxxyw9Md3rg5Ao9q_VECFGSsqfoihPSluLX6Pcxz4stseaEc8Buiik6O2EIoUV33g_XYlMNudg5pnZlk8fObn6nlui30pK6QsnR45hO4NbYisWEp20ebbnn9zRX63bWx-rwdygp2p18i29xPbcCc9s6XOBnhF_3ohlW29nW8lxjfY6eBDtVePEQb9C3D--_Hj91d18-fj7e3nWOC7Z2YvBe2pF6pq0PVHup7QAyKD5qqfl4YAfKnRKKhuC501qPw4EGOghJAw-E36DXl7pLyT82qKuZ23thmmyCvFXDiOScaSFUQ4cL6kqutUAwS4mzLWdDidk9Midz8cjsHhkiTPOoyV49dNjGGfw_0V9TGvDuAkD7Z5tGMdVFSA58LG26xuf4_w5_ADTXqK0</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>Lee, Jung Hwan</creator><creator>Shin, Kyoung-ho</creator><creator>Bahk, Sung Jin</creator><creator>Lee, Goo Joo</creator><creator>Kim, Dong Hwan</creator><creator>Lee, Chang-Hyung</creator><creator>Kim, Du Hwan</creator><creator>Yang, Hee Seung</creator><creator>Lee, Sang-Ho</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2680-6953</orcidid></search><sort><creationdate>201812</creationdate><title>Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis</title><author>Lee, Jung Hwan ; Shin, Kyoung-ho ; Bahk, Sung Jin ; Lee, Goo Joo ; Kim, Dong Hwan ; Lee, Chang-Hyung ; Kim, Du Hwan ; Yang, Hee Seung ; Lee, Sang-Ho</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-64dd7ab1d29adf19d79a4e7f83b9793b52513c8681ffd3c999b451f14671f3f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anesthesia, Caudal - methods</topic><topic>Anesthesia, Epidural - adverse effects</topic><topic>Caudal</topic><topic>Disc herniation</topic><topic>Epidural steroid injection</topic><topic>Humans</topic><topic>Injections, Epidural - methods</topic><topic>Intervertebral Disc Displacement - drug therapy</topic><topic>Low Back Pain - drug therapy</topic><topic>Lumbosacral Region</topic><topic>Meta-analysis</topic><topic>Pain Management - methods</topic><topic>Steroids - administration & dosage</topic><topic>Systemic review</topic><topic>Transforaminal</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Jung Hwan</creatorcontrib><creatorcontrib>Shin, Kyoung-ho</creatorcontrib><creatorcontrib>Bahk, Sung Jin</creatorcontrib><creatorcontrib>Lee, Goo Joo</creatorcontrib><creatorcontrib>Kim, Dong Hwan</creatorcontrib><creatorcontrib>Lee, Chang-Hyung</creatorcontrib><creatorcontrib>Kim, Du Hwan</creatorcontrib><creatorcontrib>Yang, Hee Seung</creatorcontrib><creatorcontrib>Lee, Sang-Ho</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Jung Hwan</au><au>Shin, Kyoung-ho</au><au>Bahk, Sung Jin</au><au>Lee, Goo Joo</au><au>Kim, Dong Hwan</au><au>Lee, Chang-Hyung</au><au>Kim, Du Hwan</au><au>Yang, Hee Seung</au><au>Lee, Sang-Ho</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis</atitle><jtitle>The spine journal</jtitle><addtitle>Spine J</addtitle><date>2018-12</date><risdate>2018</risdate><volume>18</volume><issue>12</issue><spage>2343</spage><epage>2353</epage><pages>2343-2353</pages><issn>1529-9430</issn><eissn>1878-1632</eissn><abstract>Epidural steroid injection has been used to treat back or radicular pain from lumbar and lumbosacral disc herniation (LDH). However, the superiority of transforaminal injection (TFESI) to caudal injection (CESI) remains controversial.
This systematic review and meta-analysis aimed to investigate whether TFESI was more useful than CESI for achieving clinical outcomes in patients with LDH.
A systematic review and/or is not appropriate. A systematic review and meta-analysis. Spine hospital and tertiary care hospital.
Articles were chosen that compared the clinical efficacy of TFESI and CESI for treatment of low back and radicular leg pain caused by LDH.
Visual analogue scale, numeric rating scale, and Oswestry disability index.
A literature search was performed using MEDLINE, EMBASE, Cochrane review, and KoreaMed databases for studies published until July 2017. After reviewing titles, abstracts, and full-texts of 6,711 studies after initial database search, six studies were included in a qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from four studies and were analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the grading of recommendations assessment, development and evaluation methodology.
Among six studies, four articles supported the superiority of TFESI to CESI, one article showed no significant difference, and one article supported the superiority of CESI to TFESI. To obtain compatible or superior clinical results to TFESI, CESI might need to inject a larger amount of medication than was usually used. A meta-analysis showed short-term and long-term trends toward better clinical efficacy with TFESI than with CESI without statistical significance. The evidence level was low because of inconsistency and imprecision.
Comprehensive reviews of selected articles revealed better clinical benefits with TFESI than with CESI, possibly because TFESI had the ability to deliver medication directly into the target area. Because of a low level of evidence and no significant results on meta-analysis, TFESI could be weakly recommended over CESI.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30030083</pmid><doi>10.1016/j.spinee.2018.06.720</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2680-6953</orcidid></addata></record> |
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subjects | Anesthesia, Caudal - methods Anesthesia, Epidural - adverse effects Caudal Disc herniation Epidural steroid injection Humans Injections, Epidural - methods Intervertebral Disc Displacement - drug therapy Low Back Pain - drug therapy Lumbosacral Region Meta-analysis Pain Management - methods Steroids - administration & dosage Systemic review Transforaminal |
title | Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis |
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