“Side-effects (types and prevalence) following Transforaminal Epidural (Cortico)Steroid Injections (TFESI) in the lumbar spine of patient suffering from Lower Back Pain (LBP) with Lower Extremity (LEX) radicular pain of diagnosed intervertebral disc herni

Item

Title
“Side-effects (types and prevalence) following Transforaminal Epidural (Cortico)Steroid Injections (TFESI) in the lumbar spine of patient suffering from Lower Back Pain (LBP) with Lower Extremity (LEX) radicular pain of diagnosed intervertebral disc herni
Author(s)
Nairac, C
Abstract
Background TFESI are used as pain management for lower back pain with radicular lower extremity symptoms. Their efficacy has been recognised and reviewed separately for patient populations suffering from specific underlying conditions to their LBP. However, the side-effects of TFESI have to date only been reviewed in mixed pathology patient populations. The present review will focus on the side effects for a specific pathology population – that is those suffering from lower back pain with an IVDH origin. Objective The objective was to pool data only for the specific IVDH patient population into tables, list the side-effects reported, calculate their prevalence rates and discuss and compare the results obtained for this specific population with those obtained in larger studies covering mixed-pathology populations. Design Structured literature review of randomised and non-randomised control trials between 2014 and 2019. Methods A systematic search of five databases (Cochrane Library; Google Scholar; Science Direct; NHS Evidence; and PubMed) was done in October 2019. The results obtained were screened according to exclusion/inclusion criteria. The Methodological Quality Assessment of the RCT was done using the Cochrane Risk of Bias Tool and a level of evidence allocated to each study type. Results Thirteen studies were selected covering 681 patients and 755 Transforaminal Epidural Steroid Injection (TFESI) which reported 23 different side-effects. No major complications were observed throughout this review’s studies. 23 types of mild transient side effects were reported. Prevalence rates were calculated globally and per side-effect reported. Discussion Side-effect reporting is not systematic in the literature. Risks of over and under-reporting exist. Whilst the types of side-effect reported for TFESI in solely IVDH patient population reflect that of the broader literature studying mixed diagnostic populations, the prevalence rates found in this study were usually high. This study does not conclude that there are major differences in types of side-effect manifestation between IVDH patients and others suffering from similar symptoms from different diagnosed causes yet receiving the same treatment. Other confounding factors may be more significant, such as patient age, sex, level of stress and depression as some correlation have been observed yet no causality established. Future research into systemic effects of ESI at low dose, such as localised or axial bone mass demineralisation is necessary to assess this understudied potential consequence of ESI and be able to better appreciate the risks linked to TFESI. Conclusion Very rare serious complications are possible with TFESI in the lumbar spine. It is more likely that three in twenty patients may develop a transient minor side-effect. Bone demineralisation following low dose exposure of locally injected corticosteroid is suspected in the literature yet more research is needed to ascertain the long term systemic risks associated with TFESI or ESI in general.
presented at
European School of Osteopathy
Date Accepted
2020
Date Submitted
28.10.2020 18:08:19
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
16680
Inst-Identifier
1229
Keywords
Adverse events types; Lumbar Intervertebral Disc herniation/bulge/protrusion/sequestration (L-IVDH); Prevalence; Transforaminal Corticosteroid Epidural Injection (TFESI).
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0
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Thesis

Nairac, C, ““Side-effects (types and prevalence) following Transforaminal Epidural (Cortico)Steroid Injections (TFESI) in the lumbar spine of patient suffering from Lower Back Pain (LBP) with Lower Extremity (LEX) radicular pain of diagnosed intervertebral disc herni”, Osteopathic Research Web, accessed April 28, 2024, https://www.osteopathic-research.com/s/orw/item/175