The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections: A systematic review with comprehensive analysis of the published data

on behalf of the Standards Division of the Spine Intervention Society

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Objective. To determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections. Design. Systematic review of the literature with comprehensive analysis of the published data. Interventions. Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. Outcome Measures. The primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence. Results. The search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies. Conclusions. The body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant shortterm improvement in pain.

Original languageEnglish (US)
Pages (from-to)239-251
Number of pages13
JournalPain Medicine (United States)
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Epidural Injections
Steroids
Pain
Evidence-Based Medicine
Opioid Analgesics
Observational Studies
Publications
Pathologic Constriction
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{3db1f8ac0a554e559ed4895c722413f9,
title = "The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections: A systematic review with comprehensive analysis of the published data",
abstract = "Objective. To determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections. Design. Systematic review of the literature with comprehensive analysis of the published data. Interventions. Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. Outcome Measures. The primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence. Results. The search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies. Conclusions. The body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant shortterm improvement in pain.",
author = "{on behalf of the Standards Division of the Spine Intervention Society} and Sharma, {Anil K.} and Yakov Vorobeychik and Ronald Wasserman and Jessica Jameson and Maxim Moradian and Belinda Duszynski and Kennedy, {David J.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1093/pm/pnw131",
language = "English (US)",
volume = "18",
pages = "239--251",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "2",

}

The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections : A systematic review with comprehensive analysis of the published data. / on behalf of the Standards Division of the Spine Intervention Society.

In: Pain Medicine (United States), Vol. 18, No. 2, 01.02.2017, p. 239-251.

Research output: Contribution to journalReview article

TY - JOUR

T1 - The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections

T2 - A systematic review with comprehensive analysis of the published data

AU - on behalf of the Standards Division of the Spine Intervention Society

AU - Sharma, Anil K.

AU - Vorobeychik, Yakov

AU - Wasserman, Ronald

AU - Jameson, Jessica

AU - Moradian, Maxim

AU - Duszynski, Belinda

AU - Kennedy, David J.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objective. To determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections. Design. Systematic review of the literature with comprehensive analysis of the published data. Interventions. Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. Outcome Measures. The primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence. Results. The search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies. Conclusions. The body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant shortterm improvement in pain.

AB - Objective. To determine the effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections. Design. Systematic review of the literature with comprehensive analysis of the published data. Interventions. Three reviewers with formal training in evidence-based medicine searched the literature on fluoroscopically guided lumbar interlaminar epidural steroid injections. A larger team consisting of five reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. Outcome Measures. The primary outcome assessed was pain relief. Other outcomes such as functional improvement, reduction in surgery rate, decreased use of opioids/medications, and complications were noted, if reported. The evidence on each outcome was appraised in accordance with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system of evaluating evidence. Results. The search yielded 71 primary publications addressing fluoroscopically guided lumbar interlaminar epidural steroid injections. There were no explanatory studies and all pragmatic studies identified were of low quality, yielding evidence comparable to observational studies. Conclusions. The body of evidence regarding effectiveness of fluoroscopically guided interlaminar epidural steroid injection is of low quality according to GRADE. Studies suggest a lack of effectiveness of fluoroscopically guided lumbar interlaminar epidural steroid injections in treating primarily axial pain regardless of etiology. Most studies on radicular pain due to lumbar disc herniation and stenosis do, however, report statistically significant shortterm improvement in pain.

UR - http://www.scopus.com/inward/record.url?scp=85035038797&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85035038797&partnerID=8YFLogxK

U2 - 10.1093/pm/pnw131

DO - 10.1093/pm/pnw131

M3 - Review article

C2 - 28204730

AN - SCOPUS:85035038797

VL - 18

SP - 239

EP - 251

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 2

ER -