Injection therapy for lumbar radiculopathy. Current Opinion in Orthopedics
Purpose of review: To review critically the available trials investigating the utility
of epidural steroid injections to treat lumbosacral radiculopathy.
Recent findings: A medical literature search was conducted using MEDLINE, OVID, PubMed,
EMBASE, and MDConsult for articles published from 1 December 2003 to January 2005
that incorporated the key words epidural, lumbar, transforaminal, caudal, selective
nerve root blocks, spinal, injections, and radiculopathy separately or in combination.
Subsequently, the studies were divided into interlaminar, caudal, and transforaminal
epidural injections. We included all publications, whether a full article or an abstract,
on the utility of epidural steroid injections to treat lumbosacral radiculopathy.
Data were compiled for each of the following categories: documentation of technique,
number of patients, outcome measures, follow-up intervals, and results and reported
complications. The minimal volume of contrast dye (0.5-2.0 ml) is required to reach
the anterior epidural space by transforaminal epidural injections. Our analysis found
that all approaches to the interlaminar, caudal, and transforaminal epidural space
provide long-term relief in 27-56% patients.
Summary: Although conclusive evidence is lacking, epidural space steroid instillation
via the transforaminal approach for the treatment of lumbar radicular pain seems
effective. Three common techniques are used to deliver medication into the epidural
space. Of these, a transforaminal approach seems to be the best route for delivering
medication to the ventral epidural space and/or the dorsal root ganglia.
