Korean J Pain.  2015 Apr;28(2):75-87. 10.3344/kjp.2015.28.2.75.

What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

• Manchikanti L
• Staats PS
• Nampiaparampil DE
• Hirsch JA

• KMID: 2278263
• DOI: http://doi.org/10.3344/kjp.2015.28.2.75

Abstract

BACKGROUND
Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery.
METHODS
A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V.
RESULTS
Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar.
CONCLUSIONS
The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.

Keyword

Discogenic pain; Epidural injections; Lumbar disc arthroplasty; Lumbar fusion; Randomized trials

MeSH Terms

Arthroplasty
Humans
Injections, Epidural*
Lower Extremity
Radiculopathy
Sacroiliac Joint
Treatment Failure
Zygapophyseal Joint

Figure

• 

  Fig. 1 Flow diagram illustrating published literature evaluating lumbar fusion/disc arthroplasty and epidural injections in lumbar discogenic pain.

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