Fromm Minjin K, Liu Shao-Hsien, Carr Catherine, Stefancic Elizabeth, Rogalski Michael
Department of Orthopedics and Physical Rehabilitation, UMass Chan Medical School, Worcester, MA, United States.
N Am Spine Soc J. 2025 Jan 28;21:100592. doi: 10.1016/j.xnsj.2025.100592. eCollection 2025 Mar.
Despite numerous studies, the factors contributing to clinical success after a lumbar transforaminal epidural steroid injection (LTFESI) for radicular pain remain unclear. The aim of this study was to systematically review literature evaluating preprocedural predictive factors for improved outcomes in patients receiving a LTFESI.
We searched databases including PubMed/MEDLINE, Cochrane Library, and Scopus for studies published from 2006 through 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles evaluating prognostic factors associated with outcomes after a LTFESI. Studies were excluded if articles treated patients with axial back pain or if they were not performed under imaging guidance with contrast medium. The quality of included studies was appraised by 2 reviewers using the Quality in Prognosis Studies tool (QUIPS).
Eighteen studies met eligibility criteria which evaluated prognostic factors across domains including patient characteristics, clinical findings, magnetic resonance imaging (MRI) characteristics, anatomical variations, and electromyography findings. The largest predictive factor studied were the MRI findings causing radicular pain. A lower grade of nerve compression and a lumbar disc herniation which was central, foraminal or extraforaminal was associated with improved outcomes, as opposed to a subarticular location. Lower paraspinal mapping scores on electromyography were correlated with better outcomes than higher scores. Outcomes were not affected if a lumbar disc herniation was accompanied by degenerative changes or if the cause of radicular pain was from a lumbar disc herniation or from lumbar spinal stenosis. The risk of bias across many domains in the studies were varied being highest overall in the domains of study attrition and study confounding.
The evidence behind factors that predict outcomes from a lumbar transforaminal epidural steroid injection have varying degrees of bias, but trends appear that can be used to guide clinical decision making.
尽管进行了大量研究，但经椎间孔腰椎硬膜外类固醇注射（LTFESI）治疗神经根性疼痛后临床成功的相关因素仍不明确。本研究的目的是系统回顾评估LTFESI患者术前预测因素对改善预后影响的文献。
我们检索了包括PubMed/MEDLINE、Cochrane图书馆和Scopus在内的数据库，查找2006年至2023年发表的研究。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，以识别评估LTFESI后与预后相关的预后因素的文章。如果文章治疗的是轴性背痛患者，或者不是在造影剂成像引导下进行的研究，则予以排除。两名评审员使用预后研究质量工具（QUIPS）对纳入研究的质量进行评估。
18项研究符合纳入标准，这些研究评估了包括患者特征、临床表现、磁共振成像（MRI）特征、解剖变异和肌电图结果等多个领域的预后因素。研究中最大的预测因素是导致神经根性疼痛的MRI表现。与关节下位置相比，较低级别的神经压迫以及中央型、椎间孔型或椎间孔外型腰椎间盘突出与更好的预后相关。肌电图上较低的椎旁映射评分与较好的预后相关，而较高的评分则相反。腰椎间盘突出伴有退变改变，或者神经根性疼痛的原因是腰椎间盘突出或腰椎管狭窄，均不影响预后。研究中许多领域的偏倚风险各不相同，总体上在研究损耗和研究混杂领域中最高。
预测经椎间孔腰椎硬膜外类固醇注射预后的因素背后的证据存在不同程度的偏倚，但似乎有一些趋势可用于指导临床决策。
