| Objective1. This study aims to assess the effectiveness of lumbar transforaminal and interlaminar epidural steroids injection to treat lumbosacral radicular pain through meta-analysis.2. To compare the effectiveness of transforaminal epidural injection among patients with Lumbar disc herniation in different syndrome classification of TCM.Methods1. The literatures comparing transforaminal and interlaminar epidural steroids injection in managing low back and radicular pain was reviewed. Data sources included relevant literature identified through searches in Pubmed, MEDLINE, EMBASE and OVID databases from 1990 to 2015. The Randomized Controlled Trials (RCT) were collected based on strict inclusions and exclusions criteras. The included articles were evaluated according to the Cochrane Handbook and the Revman 5.3 was used for meta-analysis.2. 40 patients diagnosed as LDH who underwent TFESI(transforaminal epidural steroids injection) met the inclusion criteria, including 22 patients with liver-kidney depletion (TCM syndrome) and 18 with blood stasis due to qi stagnation (TCM syndrome) were reviewed from 1st, Jan,2012 to 31th, Jan,2015. Of liver-kidney depletion group,there were 11 males and 11 females, with a mean age of 60±14.5 years old, pain duration of 18.6±20.6 months,8 cases with single segment injection and 14 with double segments injections. While in the blood stasis due to qi stagnation group, there were 10 males and 8 females, with a mean age of 62±17.9 years old, pain duration of 13.2±22.2 months,9 cases with single segment injection and 9 with double segments injections. Visual Analogue Scale(VAS) scores, Oswestry Disability Index(ODI) scores and JOA scores pre-injection,2 weeks,1 month and 6 months post-injection were recorded.RESULTS1. The initial search identified 378 papers. After screening,9 RCTs of 527 patients,264 undergoing TFESI and 295 undergoing ILESI in were recruited, including 8in English and 1 in French. According to the Revised Jadad scoring system,2 articles were 5 scores,3 were 6 and 4 was 7. The meta analysis showed there was statistically significance of VAS scores between TFESI and ILESI at 2 weeks (MD=-0.91,95%CI [-1.28,-0.54], P< 0.05), but not at 4 weeks,12weeks or 24 weeks post-injection (MD=0.31,95%CI[-0.38,2.1],P> 0.05; MD=0.14,95%CI[-0.05,0.34],P>0.05; MD=0,95%CI [-0.35,0.35],P> 0.05),neither of finger-to-floor distance (MD=1.21,95%CI [-6.41,8.82], P >0.05) and schober index (MD=0.07,95%CI [-0.42,0,57], P>0.05)at 1 months post-injection, and ODI scores at 12 weeks and 24 weeks post-injection (MD=0.67,95%CI [-1.22,2.56], P>0.05; MD=O.75,95%CI [-1.17,2.68], P>0.05).2. The VAS, ODI and JOA scores decreased significantly of both groups at the specified follow-up time after injections, and VAS scores increased significantly in liver-kidney depletion group in 2 weeks,4weeks and 6 months post-injection(P<0.05), while no difference(P>0.05) among the intra-group after injections in blood stasis due to qi stagnation group. The inter-group comparison was significantly in favor of blood stasis due to qi stagnation group in VAS and JOA scores at 4 weeks and 6 months post-injection(P<0.05).while no difference of ODI scores or surgery rates between them.CONCLUSION1. Both TFESI and ILESI are effective in reducing pain and improving functional scores in unilateral LSRP(lumbar spine radicular pain). However, TFESI demonstrated significant superiority to ILESI only at the 2-week follow-up. Based on 2 studies, there were no difference between ILESI and TFESI in functional improvement.2. TFESI achived satisfied mid-term results in treating LSRP. Although the blood stasis due to qi stagnation group showed no superiority to the Liver-kidney deleption group in short-term, it benefited more in the mid-term. |
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