Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids?

Abstract

To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. 531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported 'improvement' was assessed using the Patients Global Impression of Change (PGIC) at 1day, 1week and 1month post-injection. Descriptive and inferential statistics were applied. Patients receiving particulate steroids had statistically significantly higher NRS change scores (p = 0.0001 at 1week; p = 0.0001 at 1month). A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1week and 1month post injection (p = 0.0001) and they were significantly less likely to report worsening at 1week (p = 0.0001) and 1month (p = 0.017). Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall 'improvement' at 1week and 1month compared to the patients treated with non-particulate steroids. • CT-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. • Good outcomes with particulate steroids. • Less pain relief in patients with non-particulate steroids. • Less improvement in patients with non-particulate steroids.