title: The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain: A Systematic Review and Meta-Analysis.
abstract: Epidural steroid injection (ESI) is one of the most commonly used treatments for radiculopathy. Previous studies have described the effectiveness of ESI in the management of radiculopathy. However, controversy exists regarding the route that is most beneficial and effective with respect to the administration of epidural steroids, as both transforaminal (TF) and caudal (C) routes are commonly used.This analysis reviewed studies comparing the effectiveness of TF-ESIs with that of C-ESIs in the treatment of radiculopathy as a means of providing pain relief and improving functionality. This meta-analysis was performed to guide clinical decision-making.The study was a systematic review of comparative studies.A systematic literature search was performed using the PubMed, EMBASE, and Cochrane Library databases for trials written in English. The randomized trials and observational studies that met our inclusion criteria were subsequently included. Two reviewers, respectively, extracted data and estimated the risk of bias. All statistical analyses were performed using Review Manager 5.3.Six prospective and 2 retrospective studies involving 664 patients were included. Statistical analysis was performed utilizing only the 6 prospective studies. Although slight pain and functional improvements were noted in the TF-ESI groups compared with the C-ESI groups, these improvements were neither clinically nor statistically significant.The limitations of this meta-analysis resulted primarily from the weaknesses of the comparative studies and the relative paucity of patients included in each study.Both the TF and C approaches are effective in reducing pain and improving functional scores, and they demonstrated similar efficacies in the management of lumbosacral radicular pain.
authors.affiliation: From the Department of Orthopedics (JL, HZ, LL, JJ, ZS, XY, QW, SF), Tianjin Medical University General Hospital, No. 154 Anshan Road; Key Laboratory of Immuno Microenvironment and Disease of the Educational Ministry of China (XL), Department of Immunology, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District; and Department of Orthopedic Trauma (JJ), Tianjin Hospital, No. 406 Jiefangnan Road, Hexi District, Tianjin, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Hengxing
authors.initials: H
authors.lastname: Zhou
authors.forename: Lu
authors.initials: L
authors.lastname: Lu
authors.forename: Xueying
authors.initials: X
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Jia
authors.forename: Zhongju
authors.initials: Z
authors.lastname: Shi
authors.forename: Xue
authors.initials: X
authors.lastname: Yao
authors.forename: Qiuli
authors.initials: Q
authors.lastname: Wu
authors.forename: Shiqing
authors.initials: S
authors.lastname: Feng
mesh_terms: D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D017116:Low Back Pain / Q000188:drug therapy / Q000209:etiology; D008161:Lumbosacral Region; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D011843:Radiculopathy / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids