Clinical Utility of Transforaminal Epidural Steroid Injection: A Systematic Review and Meta-Analysis to Study the Predictors of Favorable Surgical Outcomes

TL;DR

This study identifies factors that predict successful outcomes for transforaminal epidural steroid injections, including patient age, symptom duration, and MRI findings.

Contribution

The study provides a systematic review and meta-analysis to identify clinical and radiological predictors of successful TFESI outcomes.

Findings

Younger patients with shorter symptom duration and lower BMI had better outcomes.

Certain MRI findings like low-grade nerve root compression predicted improved results.

Anatomical variations and severe central stenosis were linked to poor outcomes.

Abstract

The study analyzes current data based on clinical, radiological, and procedural parameters in order to determine predictors of effective transforaminal epidural steroid injection (TFESI) results. The systematic review and meta-analysis (PROSPERO: CRD42024497170) implemented PRISMA and Cochrane guidelines for its methodology. The search of multiple databases during the last 20 years resulted in 30 studies that met the criteria for evaluating TFESI outcome predictors. The research team conducted data extraction and quality assessment, followed by random-effects proportion-based meta-analysis to present findings through tables and forest plots, and risk-of-bias analysis. The meta-analysis evaluated 56 prognostic factors for TFESI outcomes. Findings showed that better outcomes occurred in younger patients who had a shorter symptom duration, lower body mass index, and no previous spine surgery history. Likewise, certain disc herniation locations, low-grade nerve root compression, and contrast distribution patterns were shown to be imaging markers for improved results. Poor treatment outcomes were associated with anatomical variations, facet tropism, and severe central stenosis. Overall evidence was heterogeneous, although electrodiagnostic results and procedural accuracy also had an impact. The study identified a number of factors that influence lumbar transforaminal epidural steroid injection procedure success rates. Shorter duration of symptoms, no prior surgery, and certain MRI findings were more dependable; however, demographic considerations indicated inconsistent results.

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