Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks: Comparison of outcomes in 494 patients with lumbar radiculopathy

Abstract

Purpose: We set out to compare outcomes in CT-guided lumbar transforaminal nerve root block patients receiving either particulate or non-particulate corticosteroids.

Materials and methods: This was a retrospective comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients. 321 received particulate and 173 non-particulate corticosteroids at CT-guided transforaminal lumbar nerve root injections. The particulate steroid was used from October 2009 until May 2014 and the non-particulate steroid was used from May 2014. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week and 1 month. Overall 'improvement' was assessed using the Patients' Global Impression of Change (PGIC) at these same time points (primary outcome). The proportions of patients 'improved' were compared between the two groups using the Chi-square test. The NRS change scores were compared using the unpaired t-test.

Results: A significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2 % vs. 27.7 %, p = 0.001) and at 1 month (44.3 % vs. 33.1 %, p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007).

Conclusion: Particulate corticosteroids have significantly better outcomes than non-particulate corticosteroids.

Key points: • Better pain relief is achieved with particulate steroids. • Significantly more patients report overall 'improvement' with particulate steroids. • Significantly more patients report 'worsening' at 1 week with non-particulate steroids.

Keywords: CT guided; Epidural injections; Lumbar; Steroids; Transforaminal; Treatment outcomes.