Background/Purpose: Low back pain of mechanical origin is a major cause of disability and surgical intervention. The lumbar computed tomography (CT)-guided steroid infiltration can accelerate the recovery process and sometimes avoid the surgery. Our aim was to review the indications, efficacy and complications of this technique in a wide series of unselected patients. In addition a comparative study of efficacy was performed according to the lumbar underlying pathology, type of steroid and approach of injection.

Methods: Study of lumbar CT-guided steroid injections performed in a University Hospital between January 2012 and June 2015. The minimum follow-up was 3 months. The procedure was performed in patients with low back pain refractory to standard medical therapy and Lumbar Spine Rehabilitation. Efficacy was assessed at 1 and 3 months according to a semiquantitative scale as the pain response as a) total response, b) partially c) no or d) worsening pain. A comparative study of the efficacy and safety was performed, regarding: a) underlying pathology, b) approach of injection and c) the different types of steroids used. Fisher’s test and Chi2 and the SAS System for Windows V program 9.2.were used for statistical analysis.

Results: During the study period 258 procedures were performed in 171 patients (132 men / 126 women) with a mean age ± SD of 58.24±13.45 years (range, 18-88). The indications for the injection were: a) disc herniation (44.57%), b) lumbar stenosis (34.11%), c) postoperative fibrosis and spondylolisthesis (20.15%) and d) facet joint synovial cysts syndrome (1.17%). Approaches used were: a) posterior epidural (24.42%), b) lateral recess (58.91%), and c) foraminal (16.67%). The chosen steroid was triamcinolone (74.81%), dexamethasone (23.64%) and methylprednisolone (1.55%). In a significant proportion of the procedures improvement in the patient´s sintomatology was reported at the first month, regardless of the indication, route of corticosteroid injection and steroid used (TABLE). Regarding the overall outcome, at 3 months 72.48% of the patients experienced clinical improvement. And only 21.71% of patients required a subsequent surgery. The clinical efficacy showed no statistically significant differences according to the indication of the procedure or the route used for the injection. However, the improvement of pain was significantly greater in patients treated with triamcinolone than those treated with dexamethasone (p = 0.01). Regarding safety there were 6 (2.3%) local complications (puncture of the thecal sac) and 3 (1.16%) systemic complications (allergic reaction). None of these complicationes were of clinical relevance and they were not associated with the corticosteroid used.

Conclusion:  CT-guided corticosteroid injection is an effective and safe treatment in low back pain refractory to standard medical therapy in patients with spinal stenosis, disc herniation and postoperative fibrosis. Triamcinolone infiltration seems to be more effective than dexamethasone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lumbar-ct-guided-steroid-infiltration-on-the-refractory-low-back-pain-study-of-258-procedures-in-the-same-center/