title: Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids?
abstract: OBJECTIVE
  To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids.
  
  
  METHODS
  531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported 'improvement' was assessed using the Patients Global Impression of Change (PGIC) at 1 day, 1 week and 1 month post-injection. Descriptive and inferential statistics were applied.
  
  
  RESULTS
  Patients receiving particulate steroids had statistically significantly higher NRS change scores (p = 0.0001 at 1 week; p = 0.0001 at 1 month). A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1 week and 1 month post injection (p = 0.0001) and they were significantly less likely to report worsening at 1 week (p = 0.0001) and 1 month (p = 0.017).
  
  
  CONCLUSIONS
  Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall 'improvement' at 1 week and 1 month compared to the patients treated with non-particulate steroids.
  
  
  CONCLUSIONS
  • CT-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. • Good outcomes with particulate steroids. • Less pain relief in patients with non-particulate steroids. • Less improvement in patients with non-particulate steroids.
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland. susanne.bensler@balgrist.ch.|Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland. susanne.bensler@balgrist.ch.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bensler
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.|Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Sutter
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.|Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
authors.forename: Christian W A
authors.initials: CWA
authors.lastname: Pfirrmann
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.|Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Peterson
mesh_terms: D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; C018038:dexamethasone acetate; D014222:Triamcinolone Acetonide
keywords: CT guided; Epidural injections; Lumbar spine; Non-particulate steroids; Particulate steroids