Table 1.
Epidural steroid injections for disk herniation studies.
| Author, Year | Study Design | Study Protocol | Outcome Measures | Summary of Findings | |
|---|---|---|---|---|---|
| Steroid Injection | Control | ||||
| Sariyildiz MA, 2017 [40] | Prospective (repeated measures) | Transforaminal, 40 mg betamethasone + lidocaine 2% | Baseline | VAS, Oswestry Disability Index (ODI), hospital anxiety and depression scale, and Pittsburgh Sleep Quality Index (PSQI) | Compared to baseline measurements, there were significant improvements (> 50%) in radicular pain, ODI, depressive symptoms and PSQI scores at two weeks and 12 months after injection |
| Guclu B, 2020 [41] | Prospective (repeated measures) | Transforaminal 3 mL 0.33% lidocaine + 4 mg dexamethasone |
Baseline | VAS scores at 12 weeks | Transforaminal epidural steroid injection is effective in relieving radicular pain, especially in paramedian lumbar disk herniation |
| Kennedy DJ, 2017 [46] | Prospective | Transforaminal epidural steroid injection | Baseline | Presence of recurrent or persistent pain, pain within the previous week, current opioid use for radicular symptoms, need for additional spinal injections, progression to surgery and unemployment due to pain | Despite a high success rate at 6 months, the majority of subjects experienced a recurrence of symptoms at some time during the subsequent 5 years. Few reported current symptoms and a small minority required additional injections, surgery or opioid pain medications |
| Manchikanti L, 2014 [29] | RCT, double-blind | Transforaminal 1% lidocaine, followed by 3 mg or 0.5 mL betamethasone | 1.5 mL 1% lidocaine + 0.5 mL sodium chloride | Numeric Rating Scale (NRS), Oswestry Disability Index 2.0 (ODI), opioid intake | At 2 years, there was significant improvement in all participants, although there was a lack of evidence of the superiority of steroids compared to local anesthetic |
| Manchikanti L, 2014 [30] | RCT, double-blind | Interlaminar 0.5% lidocaine (6 mL) + 1 mL betamethasone | 0.5% lidocaine (6 mL) | Numeric Rating Scale (NRS), Oswestry Disability Index 2.0 (ODI), opioid intake | Improvement in 70% of the steroid group and 60% of the control group at the end of 2 years. |
| Manchikanti L, 2013 [31] | RCT, double-blind | Interlaminar 0.5% lidocaine (5 mL) + 1 mL betamethasone | 0.5% lidocaine (6 mL) | Pain relief and functional status improvement of ≥ 50% | 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 |
| Buchner M, 2000 [47] | RCT | Interforaminal 100 mg methylprednisolone in 10 mL bupivacaine 0.25% | 10 mL bupivacaine 0.25% | VAS, straight leg raising test and functional status | No significance on pain relief, improvement of straight leg raising and improvement of functional status at 6 weeks and 6 months |
| Vad VB, 2002 [44] | RCT | Transforaminal epidural steroid injection | Saline trigger-point injection | VAS, patient satisfaction scale, Roland–Morris low back pain questionnaire | At 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, vs. 48% for the control group |
| Butterman GR, 2004 [49] | Prospective | Epidural steroid injection | Baseline | VAS, Oswestry Disability Index [ODI], pain diagram | At 2 years, it was beneficial for a small number of patients with advanced disk degeneration and chronic low back pain. It was more effective in discogenic inflammation |
| Manchikanti L, 2008 [45] | RCT | Caudal epidural injections with 9 mL 0.5% lidocaine mixed with 1 mL steroid (6 mg betamethasone or 40 mg methylprednisolone) | Caudal epidural injections with 0.5% lidocaine 9 mL | NRS, ODI, opiod intake | Comparable efficacy in both groups at 12 months |
| Radcliff K, 2012 [50] | Prospective | Epidural steroid injection | No epidural steroid injection | VAS, ODI, patient satisfaction | No improvement in short- or long-term outcomes (4 years) compared to patients who were not treated with ESIs |
| Şencan S, 2020 [48] | Retrospective | Transforaminal epidural steroid injection | Baseline | NRS | A decreased pain scores at 1 h is a predictor for a favorable 3-month response to an ESI |
LDH = lumbar disk herniation; VAS = visual analogue scale; FU = follow-up; ESI = epidural steroid injections.