• Zachary L McCormick, Daniel Cushman, Benjamin Marshall, Mary Caldwell, Jaymin Patel, Leda Ghannad, Christine Eng, Steven Makovitch, Ashwin Babu, Samuel K Chu, Christina Marciniak, David R Walega, Joel Press, Christopher Plastaras, and David J Kennedy.
• Department of PM&R, Northwestern Feinberg School of Medicine/The Rehabilitation Institute of Chicago, 345 East Superior St, Chicago, IL 60605(∗). Electronic address: zmccormi@gmail.com.
• PM R. 2016 Nov 1; 8 (11): 1039-1045.

BackgroundThe corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature.ObjectiveTo determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy.DesignMulticenter retrospective cohort study.SettingTwo tertiary academic spine centers.PatientsConsecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy.InterventionsTFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG.Main Outcome MeasuresThe primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid.ResultsSeventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P = .26).ConclusionsThis study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed.Level Of EvidenceIII.Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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