Abstract
Introduction: Trans-foraminal epidural steroid injections (TFESI) have been extensively used for treatment of pain due to lumbosacral disc disease. There has been an ongoing debate regarding benefits and safety of non-particulate steroids over particulate steroids. We have studied outcomes following injection of methylprednisolone versus dexamethasone in symptomatic lumbosacral disc disease.
Materials and Methods: A total of 100 patients (50 in each group) were chosen and randomized to be included in either arm of the study. Patients were assessed at different time points following a one-timetrans-foraminal epidural steroid injection. Outcome was assessed using the Numerical Rating Scale (NRS).
Results: Overall, the extent, as well as duration of pain relief was significantly better in the methylprednisolone group, than in the dexamethasone group. Except for transient paraesthesias, there were no serious adverse effects in either group.
Conclusion: There is satisfactory pain relief with both the medications when used for TFESI, but the efficacy of epidural methylprednisolone is greater than dexamethasone, and the effects tend to last longer. There is no difference in adverse effects between both the drugs when used for lower lumbar epidural injections.
References
- Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, et al. Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain. Pain Physician. :48.
- Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia Following Image-Guided Transforaminal Lumbar Spine Epidural Steroid Injection: Two Case Reports. Pain Med. 2009 Nov 1;10(8):1389–94.
- Wybier M, Gaudart S, Petrover D, Houdart E, Laredo J-D. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol. 2010 Jan;20(1):181–9.
- Schneider B, Varghis N, Kennedy DJ. Ideal Corticosteroid Choice for Epidural Steroid Injections: A Review of Safety and Efficacy. Curr Phys Med Rehabil Rep. 2015 Jun 1;3(2):151–8.
- Park CH, Lee SH, Kim BI. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med Malden Mass. 2010 Nov;11(11):1654–8.
- El-Yahchouchi C, Geske JR, Carter RE, Diehn FE, Wald JT, Murthy NS, et al. The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections. Pain Med Malden Mass. 2013 Nov;14(11):1650–7.
- Kennedy DJ, Plastaras C, Casey E, Visco CJ, Rittenberg JD, Conrad B, et al. 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. Pain Med. 2014 Apr 1;15(4):548–55.
- Benzon HT, Chew T-L, McCarthy RJ, Benzon HA, Walega DR. Comparison of the Particle Sizes of Different Steroids and the Effect of DilutionA Review of the Relative Neurotoxicities of the Steroids. Anesthesiol J Am Soc Anesthesiol. 2007 Feb 1;106(2):331–8.
- Kim D, Brown J. Efficacy and Safety of Lumbar Epidural Dexamethasone Versus Methylprednisolone in the Treatment of Lumbar Radiculopathy. Clin J Pain. 2011;27(6):5.
- Noe CE, Haynsworth RF. Comparison of epidural Depo-Medrol vs. aqueous betamethasone in patients with low back pain. Pain Pract Off J World Inst Pain. 2003 Sep;3(3):222–5.
- Dreyfuss P, Baker R, Bogduk N. Comparative Effectiveness of Cervical Transforaminal Injections with Particulate and Nonparticulate Corticosteroid Preparations for Cervical Radicular Pain. Pain Med. 2006 May 1;7(3):237–42.
- Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004 Jul 1;4(4):468–74.
- Gharibo C, Fakhry M, Diwan S, Kaye AD. Conus Medullaris Infarction After a Right L4 Transforaminal Epidural Steroid Injection Using Dexamethasone. Pain Physician. :4.
- Watkins TW, Dupre S, Coucher JR. Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections. J Med Imaging Radiat Oncol. 2015;59(5):571–7.
- Manchikanti L, Candido KD, Singh V, Gharibo CG, Boswell MV, Benyamin RM, et al. Epidural Steroid Warning Controversy Still Dogging FDA. Pain Physician. :24.
- Rathmell JP, Benzon HT, Dreyfuss P, Huntoon M, Wallace M, Baker R, et al. Safeguards to Prevent Neurologic Complications after Epidural Steroid InjectionsConsensus Opinions from a Multidisciplinary Working Group and National Organizations. Anesthesiol J Am Soc Anesthesiol. 2015 May 1;122(5):974–84.
Corresponding Author
Dr Muhammad Bin Abdul Hamid
Junior Resident, Deptt of Orthopaedics, Government Medical College, Srinagar, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i6.99
