SIS: TFESI review

[lobelsteve]

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Supports use in radiculopathy from disc herniation strongly and less robust support for spinal stenosis radicular pain. Non particulate steroids as effective as particulate steroids.

 

[Laryngospasm]

Nice to have some more positive info

 

[pmrmd]

Seminal!




















Not really.


Sent from my iPhone using Tapatalk

 

[Baron S]

I know I've seen study after study comparing nonparticulate to particulate, but anecdotally I've had so many patients get a more robust and prolonged response with the latter.

Classic story I'm seeing is has tfesi with 3 weeks of relief with dex, I repeat it with triamcinolone and get 3 months of relief.

 

[Ducttape]

unfortunately, still a "comprehensive review" and as such may only be level 2 evidence... but it is positive.

The Effectiveness of Lumbar Transforaminal Injection of Steroid for the Treatment of Radicular Pain: A Comprehensive Review of the Published Data - PubMed

There is strong evidence that lumbar transforaminal injection of steroids is an effective treatment for radicular pain due to disc herniation. There is a lack of high-quality evidence demonstrating their effectiveness for the treatment of radicular pain due to spinal stenosis, though small...

www.ncbi.nlm.nih.gov

cant see full article to see the specific details on the review.



Baron, you may be influencing their perception of benefit by stating "we will try this injection next with a steroid that I know lasts a lot longer, and btw its the last one you will get for the next 3 months..."

I know, because before particulates became a no-no, that was one of my "lines"...

 

[lobelsteve]

I know I've seen study after study comparing nonparticulate to particulate, but anecdotally I've had so many patients get a more robust and prolonged response with the latter.

Classic story I'm seeing is has tfesi with 3 weeks of relief with dex, I repeat it with triamcinolone and get 3 months of relief.

No epidural lasts more than 8 weeks. You are introducing bias into your protocol. If relief more than 8 weeks it is tincture of time or the exercises/stretches reducing symptoms.

 

[Ferrismonk]

I know I've seen study after study comparing nonparticulate to particulate, but anecdotally I've had so many patients get a more robust and prolonged response with the latter.

Classic story I'm seeing is has tfesi with 3 weeks of relief with dex, I repeat it with triamcinolone and get 3 months of relief.

Reminder: Triamcinolone's package insert states you should NOT use it in the epidural space. This is different than all other steroids which are simply not FDA approved.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012041s045lbl.pdf

 

[Baron S]

Good points all around

 

[SommeRiver]

"An epidural lasts as long as it lasts, and that could be several days, several weeks, sometimes longer..."

 

[pmrmd]

Reminder: Triamcinolone's package insert states you should NOT use it in the epidural space. This is different than all other steroids which are simply not FDA approved.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012041s045lbl.pdf

For some reason I think Bristol Myers requested this change. I want to say I read that somewhere way back when but I’m not sure. Anyone know?

Edit: Found the old article. BMS requested this change obviously for liability coverage. That means something to me.

 

[manowar rules]

Tangentially related, when they have done the studies comparing TFESI to ILESI for radiculopathy, have they looked at paramedian vs midline ILESI?
I think there is a difference between a targeted paramedian ILESI and just going in and shooting wherever.

 

[SommeRiver]

They have, and IIRC paramedian is superior.