Particulate vs Non-Particulate Steroids for Transforaminal Epidural Steroid Injections: Systematic Review and Meta-analysis of the Current Literature

Background: The efficacy of particulate and non-particulate steroids in patients receivingepidural steroid injections remains unclear.Objective: The purpose of this meta-analysis was to compare the efficacy of particulateand non-particulate steroids in patients receiving epidural injections for radicular pain over 3months.Study Design: Systematic review and meta-analysis.Methods: We reviewed PubMed, PubMed Central, Scopus, Central Register of ClinicalTrials of the Cochrane Collaboration, Google Scholar, and Directory of open access journalsfor trials that compared efficacy of particulate steroid with non-particulate. A meta-analysiswas performed on treatment related to mean change in visual analogue score (VAS) betweenthe particulate and non-particulate steroids. Two authors independently reviewed the data forinclusion.Results: Seven studies comprising 3,542 patients in the particulate group and 856 patients inthe non-particulate group were included. Pooled mean maximum change of VAS was higher by0.53 (95% CI: 0.14 to 0.92; P = 0.007; I2 = 50.2%) in the particulate group compared to thenon-particulate group. The non-particulate group had a larger proportion of patients with morethan 50% pain relief than the particulate group [OR 0.81 (95% CI: 0.68 to 0.97, P = 0.024).Limitations: Limited number of trials that fit the inclusion criteria and were available foranalysis.Conclusions: As the use of particulate steroids seems to be associated with slightly betterVAS scores only, clinicians need to weigh their clinical relevance in the light of complicationsand recent FDA recommendations on the use of particulate steroids.Key words: Meta-analysis, particulate epidural steroids, non-partiuclate epidural steroids,efficacy, decrease in pain scores