SynthesisFrontiers in pain research (Lausanne, Switzerland)2026
Effectiveness of epidural steroid injections in the treatment of lumbar radiculopathy: a systematic review and meta-analysis.
Synthesis in Frontiers in pain research (Lausanne, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
11 authors.
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Abstract
Introduction: Epidural steroid injection (ESI) techniques have demonstrated effectiveness in improving short- and intermediate-term pain and disability outcomes; however, their efficacy may vary depending on the specific approach used. This meta-analysis aims to compare disability and pain outcomes among different ESI techniques - transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), and combined approaches - in patients with lumbar radiculopathy. Methods: The authors searched PubMed/MEDLINE, Scopus, and Cochrane from inception to December 16, 2025, in accordance with PRISMA guidelines. Studies comparing disability and pain outcomes between different ESIs were assessed. Random-effects meta-analyses were performed to estimate the pooled mean difference between treatment groups at different follow-up timepoints. Sensitivity analyses and publication bias assessments were conducted. Results: In total, 31 studies comprising 2,452 patients were included. Compared with ILESI, TFESI demonstrated significantly greater pain reduction at 2 weeks and 1 month of follow-up, as well as superior improvements in both disability and pain at 3 and 6 months. Compared with CESI, TFESI showed superior disability improvements at 2 weeks and 1 month, with pain outcomes remaining superior at 1 and 3 months; however, both disability and pain outcomes plateaued by 6 months. At 12-month follow-up, TFESI demonstrated improved disability scores compared with CESI, with no significant difference in pain outcomes. Across all follow-up timepoints, the combined TFESI + CESI approach was associated with significantly greater improvements in both disability and pain relief compared with TFESI alone. Conclusions: TFESI demonstrated superior short- and intermediate-term improvements in disability and pain compared with ILESI, but its advantages over CESI remained inconsistent. Limited evidence suggests that the combined TFESI + CESI approach may offer additional benefits over TFESI alone. Further prospective randomized trials are warranted to better define the efficacy and long-term outcomes of the combined approach. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261320804.
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