Сomparative effectiveness of various methods of epidural administration of glucocorticosteroids in treating root pain syndromes

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Abstract

This review aimed to compare the effectiveness of different methods of epidural glucocorticosteroid (GCS) use in the treatment of root syndrome pain according to literature over the past 20 years. A literary search was conducted in the databases of PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, as well as a manual search of bibliographies of famous primary and review articles and abstracts of scientific meetings between 2000 and 2020. During the search, 637 studies were identified, of which 615 were excluded, as they did not correspond to the topic of the article. The remaining 22 studies were included in this review.

Scientific papers describe three ways to deliver glucocorticosteroids, namely, epidural–interlaminar injection, transforaminal injection, sacral–epidural injection.

For sciatica, 5 out of 8 comparative randomized controlled trials found the transforaminal route of administration to be superior to the sacroepidural or interlaminar route of administration. In a number of studies, the sacroepidural route of administration was comparable in efficiency with transfor-real with low herniated discs.

In cases of cervicobrachialgia, the transforaminal route of administration is recognized by most authors as unsafe, with risks of accidental intravascular injection. In this regard, at the cervical level, interlaminar access is considered preferable. In addition, the differences between the epidural use of water-soluble and dispersed (not approved for use in the Russian Federation) glucocorticosteroids are described.

The review describes the techniques of various approaches to the epidural space with their advantages and disadvantages.

Different methods require different material equipment of clinics. Sacral access, with relatively high efficiency, allows for “blind” use, in contrast to transforaminal access at the lumbar level and interlaminar access at the cervical level, which require X-ray navigation.

About the authors

Dmitry A. Fedorov

Federal Siberian Research Clinical Centre; Krasnoyarsk State Medical University

Email: 293333666fedorov@gmail.com
ORCID iD: 0000-0002-1860-4609
SPIN-code: 6912-7740

anesthesiologist

Russian Federation, Krasnoyarsk; Krasnoyarsk

Vladimir V. Khinovker

Federal Siberian Research Clinical Centre; Krasnoyarsk State Medical University

Author for correspondence.
Email: vhinov@hotmail.com
ORCID iD: 0000-0002-3162-6298
SPIN-code: 8640-9591

MD, Cand. Sci. (Med.)

Russian Federation, 26, 2, Kolomenskaya st., Krasnoyarsk, 660037; Krasnoyarsk

Viktor A. Koriachkin

Saint-Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Med.), professor

Russian Federation, Saint-Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Interlaminar epidural injection with typical contrast agent spread

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3. Fig. 2. Safe puncture points. 1 – Kambin triangle, 2 – Subpedicular

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4. Fig. 3. Adamkevich artery

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5. Fig. 4. Relation of left and right localization of Adamkevich artery

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6. Fig. 5. Distribution of Adamkevich arteries at different levels of the vertebral column

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7. Fig. 6. Distribution of Adamkevic h artery in the foramen

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8. Fig. 7. Needle position in transoraminal subpedicular control. а – in projection 20°, b – in anterior-posterior projection b – in lateral projection

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9. Fig. 8. Location of the needle during transforaminal administration through the Kambin triangle

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