A Systematic Review of the Effectiveness of CT-Guided, Lumbar Transforaminal Injection of Steroids.

OBJECTIVE:

To determine the effectiveness and safety of computerized tomography (CT) guided, lumbar transforaminal injection of steroids in the treatment of radicular pain.

DESIGN:

Systematic review of published literature.

INTERVENTIONS:

Two reviewers independently assessed 19 publications on the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids.

OUTCOME MEASURES:

For effectiveness, the primary outcome was the success rate for relief of pain. For safety, the radiation exposure involved and the nature of complications were determined.

RESULTS:

Much of the literature fails to provide evidence. Two studies reported decreases in mean or median pain scores but no other data. Two 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 may involve greater radiation exposure than does fluoroscopy-guided injections and do not avoid catastrophic spinal cord injury.

CONCLUSION:

The evidence-base for CT-guided lumbar transforaminal injection of steroids is meagre. This intervention is not more effective than fluoroscopy-guided injections and is not demonstrably safer.