title: Pain Reduction and Repeat Injections After Transforaminal Epidural Injection With Particulate Versus Nonparticulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy.
abstract: 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.
  
  
  
  To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy.
  
  
  
  Multicenter retrospective cohort study.
  
  
  
  Two tertiary academic spine centers.
  
  
  
  Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy.
  
  
  
  TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  III.
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, 345 East Superior St, Chicago, IL 60605(∗). Electronic address: zmccormi@gmail.com.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
authors.affiliation: Department of PM&R, University of Utah, Salt Lake City, UT(†).
authors.forename: Daniel
authors.initials: D
authors.lastname: Cushman
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(¶).
authors.forename: Mary
authors.initials: M
authors.lastname: Caldwell
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(§).
authors.forename: Jaymin
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Northwestern University Lurie Children's Hospital, Chicago, IL(∗∗).
authors.forename: Leda
authors.initials: L
authors.lastname: Ghannad
authors.affiliation: Department of PM&R, Harvard Medical School/Spaulding, Boston, MA(††).
authors.forename: Christine
authors.initials: C
authors.lastname: Eng
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡‡).
authors.forename: Steven
authors.initials: S
authors.lastname: Makovitch
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(¶¶).
authors.forename: Ashwin
authors.initials: A
authors.lastname: Babu
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(§§).
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Chu
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(∗∗∗).
authors.forename: Christina
authors.initials: C
authors.lastname: Marciniak
authors.affiliation: Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, IL(†††).
authors.forename: David R
authors.initials: DR
authors.lastname: Walega
authors.affiliation: Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, Chicago, IL(‡‡‡).
authors.forename: Joel
authors.initials: J
authors.lastname: Press
authors.affiliation: Department of PM&R, University of Pennsylvania, Philadelphia, PA(¶¶¶).
authors.forename: Christopher
authors.initials: C
authors.lastname: Plastaras
authors.affiliation: Department of Orthopaedics, Stanford University, Palo Alto, CA(§§§).
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D000368:Aged; D001623:Betamethasone; D006801:Humans; D007268:Injections, Epidural; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone
chemical_list: D014221:Triamcinolone; D001623:Betamethasone