Comparative effectiveness of lumbar epidural steroid injections using particulate vs. non-particulate steroid: an intra-individual comparative study

To perform an intra-individual comparison for the effectiveness of lumbar epidural steroid injection (ESI) between injections using particulate (triamcinolone) and non-particulate (dexamethasone) steroid.

This study included 162 patients(M:F = 60:102, mean age 66.3 years) who underwent lumbar ESI using dexamethasone(ESI_DEXA) from April 2013 to May 2013 and who had previously underwent lumbar ESI using triamcinolone(ESI_TRIAM) within 1 year. Degree of relative satisfaction, injection-free interval and injection frequency were determined. Subgroup analyses were also done according to the diagnosis, approach-methods, patients’ ages and sex.

Eighty-seven of 139 patients (62.6 %) responded that the effect of ESI_TRIAM was better than that of ESI_DEXA (p = 0.004). In the four subgroups—patients with herniated intervertebral disc (HIVD), who underwent transforaminal ESI, were under age 70 and were male patients—the proportion of patients who preferred ESI_TRIAM was significantly greater than the proportion patients who preferred ESI_DEXA in terms of relative satisfaction (p < 0.05). The injection-free interval of ESI_TRIAM was significantly longer than that of ESI_DEXA (p = 0.01). In the subgroup analyses, the patient groups HIVD, who underwent transforaminal ESI, under age 70 and female patients with longer injection-free interval of ESI_TRIAM than ESI_DEXA were statistically significant (p < 0.05). Other factors were not significant.

The relative satisfaction with ESI_TRIAM was significantly better than that with ESI_DEXA in the same patient, and the injection-free interval after ESI_TRIAM was significantly longer than that after ESI_DEXA.