title: The role of fluoroscopic interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind trial.
abstract: BACKGROUND
  There is continued debate on the effectiveness, indications, and medical necessity of epidural injections in managing pain and disability from lumbar disc herniation, despite extensive utilization. There is paucity of literature on interlaminar epidural injections in managing lumbar disc herniation or radiculitis in contemporary interventional pain management settings utilizing fluoroscopy.
  
  
  METHODS
  A randomized, double-blind, active-control trial was undertaken to assess the effectiveness of lumbar interlaminar epidural injections with or without steroids for disc herniation and radiculitis. The primary outcome was defined as pain relief and functional status improvement of ≥ 50%. One hundred twenty patients were randomly assigned to 1 of the 2 groups. Group I patients received lumbar interlaminar injections containing a local anesthetic (lidocaine 0.5%, 6 mL), whereas Group II patients received lumbar interlaminar epidural injections of 0.5% lidocaine, 5 mL, mixed with 1 mL of non-particulate betamethasone.
  
  
  RESULTS
  In the patients who responded with initial 2 procedures with at least 3 weeks of relief, significant improvement was seen in 80% of the patients in the local anesthetic group and 86% of the patients in the local anesthetic and steroid group. The overall average procedures per year were 3.6 in the local anesthetic group and 4.1 in the local anesthetic and steroid group, with an average relief of 33.7 ± 18.1 weeks in the local anesthetic group and 39.1 ± 12.2 weeks in the local anesthetic and steroid group over a period of 52 weeks in the overall population.
  
  
  CONCLUSIONS
  Lumbar interlaminar epidural injections of local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis, with potential superiority of steroids compared with local anesthetic alone at 1 year follow-up.
authors.affiliation: Pain Management Center of Paducah, Paducah, Kentucky 42003, USA. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Falco
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008012:Lidocaine / Q000008:administration & dosage; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D011843:Radiculopathy / Q000150:complications*; D020127:Recovery of Function / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D001623:Betamethasone; D008012:Lidocaine
keywords: chronic low back pain; disc herniation; local anesthetic; lower extremity pain; lumbar interlaminar epidural injections; radiculitis; randomized controlled trial; steroids