title: Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial.
abstract: BACKGROUND
  Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation.
  
  
  OBJECTIVE
  This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation.
  
  
  METHODS
  A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain. All subjects received a single level transforaminal epidural steroid injection with either dexamethasone or triamcinolone. Repeat injections were allowed as determined by the blinded physician and subjects. Primary outcomes included: number of injections received, surgical rates, and categorical pain scores at 2 weeks, 3 months, and 6 months. Secondary outcomes included mean Oswestry Disability Index.
  
  
  RESULTS
  Both triamcinolone and dexamethasone resulted in statically significant improvements in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The surgical rates were comparable with 14.6% of the dexamethasone group and 18.9% of the triamcinolone group receiving surgery. There was a statistically significant difference in the number of injections received, with 17.1% of the dexamethasone group receiving three injections vs only 2.7% of the triamcinolone group.
  
  
  CONCLUSIONS
  Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation, and frequently only require 1 or 2 injections for symptomatic relief. Dexamethasone appears to possess reasonably similar effectiveness when compared with triamcinolone. However, the dexamethasone group received slightly more injections than the triamcinolone group to achieve the same outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
authors.forename: Christopher
authors.initials: C
authors.lastname: Plastaras
authors.forename: Ellen
authors.initials: E
authors.lastname: Casey
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Visco
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Rittenberg
authors.forename: Bryan
authors.initials: B
authors.lastname: Conrad
authors.forename: James
authors.initials: J
authors.lastname: Sigler
authors.forename: Paul
authors.initials: P
authors.lastname: Dreyfuss
mesh_terms: D000328:Adult; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014221:Triamcinolone; D003907:Dexamethasone
keywords: Corticosteroid; Dexamethasone; Disc Herniation; Lumbar; Particulate; Radicular Pain; Radiculopathy; Transforaminal Epidural Injection; Triamcinolone