Southern Rehabilitation Institute, Christchurch, New Zealand.
Pain Med. 2013 Jan;14(1):14-28. doi: 10.1111/j.1526-4637.2012.01508.x. Epub 2012 Oct 30.
To determine the effectiveness of lumbar transforaminal injection of steroids in the treatment of radicular pain.
Comprehensive review of the literature with systematic analysis of all published data.
Four reviewers independently assessed 39 publications on the effectiveness of lumbar transforaminal injection of steroids. Each reviewer determined if a publication provided any valid information on effectiveness. Assessments were compared, and the data of each publication were evaluated in terms of the rigor with which they were produced and the evidence they provided of effectiveness.
The primary outcome sought was the success rate for relief of pain. Improvement in secondary outcomes was noted if reported.
For miscellaneous conditions, the available evidence is limited and is neither compelling nor conclusive. For disc herniation, the evidence is sufficiently abundant to show that lumbar transforaminal injection of steroids is not universally effective but, nevertheless, benefits a substantial proportion of patients, and is not a placebo. Success rates are higher in patients with contained herniations that cause only low-grade compression of the nerve.
In a substantial proportion of patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery. The evidence supporting this conclusion was revealed by comprehensive review of all published data and found to be much more compelling than it would have been if the literature review had been of the limited scope of a traditional "systematic review" of randomized, controlled trials only.
确定腰椎经椎间孔注射类固醇治疗神经根痛的疗效。
对所有已发表数据进行系统分析的文献综合回顾。
四位评估员独立评估了 39 篇关于腰椎经椎间孔注射类固醇疗效的出版物。每位评估员确定出版物是否提供了任何关于疗效的有效信息。对评估进行了比较，并根据其产生的严谨性和提供的有效性证据对每份出版物的数据进行了评估。
主要结局是缓解疼痛的成功率。如果有报道，也会注意到次要结局的改善。
对于各种病症，现有证据有限，既不具有说服力也不具有结论性。对于椎间盘突出症，证据足够丰富，表明腰椎经椎间孔注射类固醇并不普遍有效，但仍使相当一部分患者受益，且并非安慰剂。对于仅引起神经低度压迫的包容性疝患者，成功率更高。
在因包容型椎间盘突出症引起的腰椎神经根痛的相当一部分患者中，腰椎经椎间孔注射皮质类固醇可有效减轻疼痛、恢复功能、减少对其他医疗保健的需求，并避免手术。支持这一结论的证据是通过对所有已发表数据进行综合回顾而揭示的，其说服力远远超过仅对随机对照试验进行传统的“系统综述”的文献综述所能达到的。
