European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Meta Analysis
Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis.
Transforaminal epidural injection of steroids is used to treat lumbar radicular pain. However, there are only a few well-designed randomized, controlled studies on the effectiveness of steroid injection. ⋯ The current meta-analysis shows that transforaminal epidural steroid injections, when appropriately performed, should result in an improvement in pain, but not disability. The three RCTs that followed patients to 3 months (and the single study to 12 months) have found no benefit by the addition of steroids. The limitations of this study include the paucity of the available literature.
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Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs. Moreover, a few neurological adverse events have been reported recently. ⋯ Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury.
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The purpose of this study is to investigate if lumbar disc pathology identified on MRI scans is more common in patients with acute, likely discogenic, low back pain than matched controls. ⋯ MRI findings including disc degeneration, modic changes and herniation are more common in selected people with current acute (likely discogenic) low back pain than in controls without current low back pain. Further investigation of the value of MRI findings as prognostic factors and as treatment effect modifiers is required to assess the potential clinical importance of these findings.
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The purpose of this study was to measure the structures of the ventral of lateral masses using cadaver specimens and to quantitatively compare the safety zone for the two major techniques used on each vertebral level from C3 to C6. ⋯ The safety width of the Magerl technique was shorter at C6 because the vertebral artery runs more laterally at C6. The height for the Magerl technique was not significantly different from C3 to C6, however, the safety height for the Roy-Camille technique was significantly shorter at C5 and C6. Our findings suggest that it is important to ensure that the screw(s) penetrate through the cranial side of the ventral aspect of a lateral mass when performing the Magerl technique at all vertebral levels, and to carefully select the screw length when using the Roy-Camille technique, especially at C5 and C6, in order to avoid nerve root injury.