Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Objective: The object of the present meta-analysis is to compare the effectiveness of transforaminal epidural steroid injection (TFESI) and interlaminar epidural steroid injection (ILESI) for treating patients with low back pain (LBP) secondary to lumbosacral radicular pain.

Methods: A systematic search was performed in the PubMed and Embase databases and the Cochrane Library for relevant literature published through January 2016. The randomized controlled trials (RCTs) and controlled observational studies were selected, which did not only compare TFESI with ILESI but also reported the available data. The Cochrane Collaboration's Handbook and Newcastle-Ottawa Scale (NOS) were used for the methodological quality assessments of the RCTs and observational studies respectively. The meta-analysis was performed using the Revman 5.2 software.

Results: A total of 931 patients from nine RCTs and four observational studies were subjected to meta-analysis. In primary outcomes, the TFESI patients experienced superior pain relief compared with the TFESI patients in RCTs (P = 0.01), but not in observational studies (p = 0.63). The pooled data of RCTs showed that the TFESI group presented superior clinical results in terms of visual analogue scale (VAS) than the ILESI group (p = 0.0005). Moreover, the numeric rating scale (NRS) specifically favored TFESI in the RCTs (p < 0000.1). Similar functional improvement and oswentry disability index (ODI) score were observed between TFESI and ILESI in RCTs (P = 0.62). In secondary outcomes, meta-analysis of RCTs and observational studies revealed that there were no statistically significant differences between both groups in regard to procedure frequency, surgery rate, and ventral epidural spread.

Conclusions: According to the results of meta-analysis, TFESI to manage LBP provides superior short term pain relief and equal functional improvement when compared to ILESI. It has not shown a statistically significant difference between both groups with regard to procedure frequency, surgery rate, and ventral epidural spread.