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Evidence lacking for CT-guided lumbar transforaminal injection of steroids

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ORLANDO, Fla. — Evidence of the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids in the treatment of radicular pain is scant, according to a presenter here.

Nikolai Bogduk, MD, presented the findings from a systematic literature review in which he and colleague John Bui, MD, assessed 19 publications on the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids. The study’s primary endpoints were success of pain relief, level of radiation exposure and the nature of complications experienced.

According to Bogduk, much of the evidence he and Bui reviewed failed to support the theory that the injection of steroids reduces radicular pain. Many of the studies and literature analyzed were general and did not contain hard data, he said.

“We saw success, but not defining. There are no numbers, just words; no data at all,” Bogduk said. “The patients were better, but we had no data. Some [studies] did not even say how many patients they treated.”

For example, two studies reported decreases in mean or median pain scores but no other data, he said. Two other studies reported success rates of between 34% and 62% for achieving 50% relief of pain at between 1 and 6 months after treatment.

CT-guided injections also do not avoid catastrophic spinal cord injuries, according to Bogduk.

“Conventional CT involves far greater radiation exposure than fluoroscopy guided injections,” he said. “There is no evidence that it is safer.”

Reference: Bogduk N. A systematic review of the effectiveness of CT-guided, lumbar transforaminal injection of steroids. Presented at: The International Spine Intervention Society Annual Meeting; July 30-Aug. 3, 2014; Orlando, Fla.

Disclosure: Bogduk is an International Spine Intervention Society consultant and author. He receives royalties from books he has published and also receives grant and research support from organizations.