The efficacy of lumbosacral transforaminal epidural steroid injections: a comprehensive literature review.

BACKGROUNDThere have been a number of recent studies showing the effectiveness of lumbosacral transforaminal steroid epidural injections used in the treatment of radicular pain. The studies include retrospective, prospective and randomized controlled studies. Thus, the data is valuable with regard to identifying evidence based recommendations that can be used for clinical practitioners.PURPOSETo review and critically evaluate literature focusing on the efficacy of lumbosacral transforaminal steroid injections. The goal of this review is to identify pertinent journal information that aids in the improvement of clinical care and guides future research by increasing the awareness of the efficacy of this procedure.STUDY DESIGNA comprehensive literature review of the efficacy of lumbar sacral transforaminal epidural steroid injections.METHODSMedical databases were searched for key words of transforaminal lumbar sacral, anatomy, and efficacy of steroid injection using Pub Med, Medline, Cochrane databases and U.S. National Library of Medicine. Works cited lists were then searched and cross-referenced as well. Articles focusing solely on interlaminar and caudal steroid injections were excluded as were transforaminal studies focusing on the cervical spine. Also, articles were excluded that did not differentiate the type of technique with type of relief it produced. Papers focusing on the efficacy of lumbosacral transforaminal steroid injections were included in the data that followed the patient for three months or greater.RESULTSIn all there were 10 randomized trials, 4 retrospective studies and 8 prospective studies found. Among the 10 randomized control studies only 8 met inclusion criteria. All 8 of the randomized control studies included show a positive outcome in both the short term and long term results. There were a total of 9 prospective trials showing a positive short term and long term outcome and that used both CT guided injections as well as fluoroscopic injections.CONCLUSIONThis systemic review included prospective, retrospective and randomized clinical trials showing that there was strong evidence for transforaminal injections in the treatment of lumbosacral radicular pain for both short term and long term relief.