A Systematic Review of the Effectiveness of CT-Guided, Lumbar Transforaminal Injection of Steroids

Authors

  • John Bui MBBS,

    Corresponding author
    1. Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia
    • Reprint requests to: John Bui, MBBS, Hunter New England Imaging, Hunter New England Area Health Service, Locked Bag 1, Newcastle Region Mail Centre, NSW 2310, Australia. Tel: +61-2-49213430; Fax: +61-2-49213428; E-mail: john.bui@hnehealth.nsw.gov.au.

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  • Nikolai Bogduk MD, PhD

    1. Newcastle Bone and Joint Institute, Royal Newcastle Centre, University of Newcastle, Newcastle, New South Wales, Australia
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Abstract

Objective

To determine the effectiveness and safety of computerized tomography (CT) guided, lumbar transforaminal injection of steroids in the treatment of radicular pain.

Design

Systematic review of published literature.

Interventions

Two reviewers independently assessed 19 publications on the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids.

Outcome Measures

For effectiveness, the primary outcome was the success rate for relief of pain. For safety, the radiation exposure involved and the nature of complications were determined.

Results

Much of the literature fails to provide evidence. Two studies reported decreases in mean or median pain scores but no other data. Two studies reported success rates of between 34% and 62% for achieving 50% relief of pain at between 1 and 6 months after treatment. CT-guided injections may involve greater radiation exposure than does fluoroscopy-guided injections and do not avoid catastrophic spinal cord injury.

Conclusion

The evidence-base for CT-guided lumbar transforaminal injection of steroids is meagre. This intervention is not more effective than fluoroscopy-guided injections and is not demonstrably safer.

Ancillary