Article

The corticosteroid choice for a lumbar transforaminal epidural
steroid injection (TFESI) remains controversial. Whether to utilize particulate
or nonparticulate steroid preparations for these injections remains an unanswered
question in the literature. OBJECTIVE: To determine if a particulate or
nonparticulate steroid is more effective in the treatment of electromyography
(EMG)-confirmed lumbosacral radiculopathy. DESIGN: Multicenter retrospective
cohort study. SETTING: Two tertiary academic spine centers. PATIENTS: Consecutive
patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy.
INTERVENTIONS: TFESI with a particulate or nonparticulate steroid to treat
radicular pain within 6 months of EMG.
MAIN OUTCOME MEASURES: The primary outcome
was the proportion of patients with >/=50% pain reduction on the numerical rating
scale after TFESI. Secondary outcomes included mean numerical rating scale score
reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate
(>/=30 days) outcomes were compared between patients who received a TFESI with a
particulate versus nonparticulate steroid. RESULTS: Seventy-eight patients, with
an age +/- standard deviation of 56 +/- 16 years and a mean symptom duration of
49 +/- 71 months, were included. Forty-one patients (52%) received dexamethasone,
23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was
no statistically significant difference in the proportion of patients who
reported >/=50% pain reduction between the particulate and nonparticulate groups
at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95%
CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI,
19-59). There was no difference in the mean number of injections administered
between groups at intermediate follow-up (P = .26). CONCLUSIONS: This study
demonstrates no significant differences in pain reduction or the number of repeat
injections with particulate compared with nonparticulate transforaminal epidural
steroid injection in patients with EMG-confirmed painful lumbosacral
radiculopathy. These findings suggest a new population for whom nonparticulate
steroid appears to be an appropriate first-line therapy, although confirmation
with a randomized study is needed.
LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS