Understanding the Landscape of Lumbar Epidural Steroid Injections: A Review of Interlaminar, Transforaminal, and Caudal Approaches.

IF 1.4 Q3 ORTHOPEDICS
Orthopedic Reviews Pub Date : 2025-05-23 eCollection Date: 2025-01-01 DOI:10.52965/001c.138210
Tommy Li, Cynthia Gonzalez, Jamie Provost, Jamal Hasoon, Anvinh Nguyen
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Abstract

Purpose of the review: Lumbar epidural steroid injections (ESIs) have been used for decades for managing lumbosacral pain, particularly in patients with radiculopathy and chronic low back pain. Despite frequent use, there remains debate regarding their overall effectiveness, fueled by variability in physician technique and differing opinions on the optimal approach. This narrative review examines the three primary methods of lumbar ESI administration-transforaminal, interlaminar, and caudal-to evaluate their respective advantages, limitations, and clinical applications.

Summary: Each ESI technique offers unique benefits and potential risks. The transforaminal approach provides targeted delivery to affected nerve roots but is associated with higher risks of complications such as nerve injury or vascular compromise. The interlaminar approach allows broader spread of injectate with a lower technical complexity but may lack precision in targeting the specific source of pain. The caudal approach, typically reserved for patients with altered spinal anatomy or prior lumbar surgery, offers the safest trajectory but often the least precise medication delivery. Outcomes with ESIs are highly variable, which contributes to the ongoing debate about their role in lumbosacral pain management.

Conclusion: Understanding the technical differences, risk profiles, and clinical indications of each lumbar ESI approach can help guide treatment planning and optimize outcomes. By tailoring the injection technique to the individual patient's anatomy and clinical presentation, physicians may improve both the efficacy and safety of epidural steroid injections in the treatment of lumbosacral pain.

了解腰椎硬膜外类固醇注射的情况:椎间、椎间孔和尾侧入路的综述。
回顾目的:腰椎硬膜外类固醇注射(ESIs)用于治疗腰骶痛已有几十年的历史,特别是对于神经根病和慢性腰痛患者。尽管经常使用,但由于医生技术的差异和对最佳方法的不同意见,关于它们的总体有效性仍存在争议。本文综述了腰椎ESI的三种主要给药方法——经椎间孔、椎间和尾侧,以评估它们各自的优点、局限性和临床应用。摘要:每一种ESI技术都有其独特的优势和潜在的风险。经椎间孔入路可靶向给药到受影响的神经根,但有较高的并发症风险,如神经损伤或血管受损。椎间入路允许更广泛的注射扩散,技术复杂性较低,但可能缺乏针对特定疼痛源的精确性。尾侧入路通常用于脊柱解剖改变或既往腰椎手术的患者,提供最安全的轨迹,但通常是最不精确的给药。ESIs的结果是高度可变的,这导致了关于其在腰骶疼痛管理中的作用的持续争论。结论:了解每一种腰椎ESI入路的技术差异、风险概况和临床适应症有助于指导治疗计划和优化结果。通过根据个体患者的解剖结构和临床表现定制注射技术,医生可以提高硬膜外类固醇注射治疗腰骶痛的有效性和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Orthopedic Reviews
Orthopedic Reviews ORTHOPEDICS-
CiteScore
2.70
自引率
4.80%
发文量
122
审稿时长
10 weeks
期刊介绍: Orthopedic Reviews is an Open Access, online-only, peer-reviewed journal that considers articles concerned with any aspect of orthopedics, as well as diagnosis and treatment, trauma, surgical procedures, arthroscopy, sports medicine, rehabilitation, pediatric and geriatric orthopedics. All bone-related molecular and cell biology, genetics, pathophysiology and epidemiology papers are also welcome. The journal publishes original articles, brief reports, reviews and case reports of general interest.
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