Evidence map›Paper›PMID 25589942›Full record

ArticleThe Korean journal of pain2015

Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: is one method superior to the other?

Laxmaiah Manchikanti, Vijay Singh, Vidyasagar Pampati, Frank Je Falco, Joshua A Hirsch

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Korean journal of pain, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 4 pooled it
11.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 4 syntheses or guidelines pooled it, 120 citations in OpenAlex.

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  4. Management of lumbar spinal stenosis.BMJ (Clinical research ed.) · 2016
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Laxmaiah ManchikantiPain Management Center of Paducah, Paducah, KY, USA. ; Pain Management Center of University of Louisville, Louisville, KY, USA.
Vijay SinghSpine Pain Diagnostics Associates, Niagara, WI, USA.
Vidyasagar PampatiPain Management Center of Paducah, Paducah, KY, USA.
Frank Je FalcoMid Atlantic Spine & Pain Physicians, Newark, DE, and Temple University Hospital, Philadelphia, PA, USA.
Joshua A HirschMassachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Pain Management Center of Paducah · USMassachusetts General Hospital · USTemple University Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEpidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches.

methodsThis manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients).

resultsAnalysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial.

conclusionsThe results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.

Indexed as

Caudal epidural steroidsDisc herniationLocal anestheticLumbar interlaminar steroidsRadiculitisTransforaminal epidural steroids

Identifiers

PMID25589942
PMCPMC4293502
OpenAlexW2105162147

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.