Studies suggest that lumbar transforaminal injection of steroids (LTFIS) can reduce radicular pain associated with disk herniation, according to a systematic literature review in Pain Medicine.

University and hospital researchers performed a systematic literature review, focusing on publications that reported efficacy outcomes or complication data associated with LTFIS for radicular pain in patients with disk herniation or lumbar spinal stenosis. Only observational, pragmatic, and explanatory studies were included to examine effectiveness of LTFIS.

For the purposes of the review, the primary outcome included the proportion of patients with a ≥50% reduction in radicular pain. Patient satisfaction, functional improvement, decreased use of pain medication, avoidance of spinal surgery, and a greater than 2-point reduction in pain score were additional outcomes of interest.


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Steroid doses ranged from 4 mg to 40 mg across the studies. Success rates of LTFIS (ie, ≥50% reduction in radicular pain) among patients with disk herniations were ~63% (range, 58%-68%) at 1 month, 74% (range, 68%-80%) at 3 months, 64% (range, 59%-69%) at 6 months, and 64% (range, 57%-71%) at 1 year. Success rates across studies of patients with lumbar spinal stenosis were 49% (range, 43%-55%) at 1 month, 48% (range, 35%-61%) at 3 months, 43% (range, 33%-53%) at 6 months, and 59% (range, 45%-73%) at 1 year.

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Limitations of the study were the retrospective nature of the review and the inclusion of observational studies with nonrandomized designs.

The researchers advised that “nonparticulate steroids should be the firstline choice of medication due to their enhanced safety profile.”

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Smith CC, McCormick ZL, Mattie R, MacVicar J, Duszynski B, Stojanovic MP. The effectiveness of lumbar transforaminal injection of steroid for the treatment of radicular pain: a comprehensive review of the published data [published online July 25, 2019]. Pain Med. doi:10.1093/pm/pnz160