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Particulate versus Nonparticulate Corticosteroids for Transforaminal Nerve Root Blocks: Comparison of Outcomes in 494 Patients with Lumbar Radiculopathy
02 March 2017 (online)
Introduction: Based on U.S. Food and Drug Administration warnings, this hospital switched from using particulate to nonparticulate corticosteroids for lumbar nerve root injections. We set out to compare outcomes in lumbar nerve root block patients receiving either particulate or nonparticulate corticosteroids.
Materials and Methods: This was a comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients: 321 received particulate and 173 received nonparticulate corticosteroids at computed tomography–guided transforaminal lumbar nerve root injections. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week, and 1 month. Overall improvement was assessed using the Patient Global Impression of Change scale at these same time points (primary outcome). The proportions of patients improved were compared between the two groups using the chi-square test. The NRS change scores were compared using the unpaired t test.
Results: A significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2% versus 27.7%; p = 0.001) and at 1 month (44.3% versus 33.1%; p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007).
Conclusion: The particulate corticosteroids have significantly better outcomes compared with nonparticulate corticosteroids. This hospital has since restarted using particulate corticosteroids.