Comparison of ultrasound-guided transforaminal epidural injection versus fluoroscopy-guided injection for lumbosacral herpes zoster: a noninferior analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background To evaluate efficacy and safety of ultrasound (US)-guided lumbar transforaminal epidural injection (TFEI) for relieving zoster-associated pain (ZAP) in lumbosacral nerves.Methods A retrospective observational cohort study was performed with 1:1 propensity matching to control cohort. Patients undergoing TFEI were included as a US cohort using US guidance and control cohort under fluoroscopy (FL) guidance. Primary endpoint was visual analog scale (VAS) pain scores at 1 month after the procedure with a non-inferiority margin of 10 mm. Secondary outcomes included sensory blockade, procedure time, radiation exposure, adverse events, rescue analgesics, post-herpetic neuralgia (PHN) incidence, and EuroQoL Five-dimension (EQ-5D) scores.Results US cohort reported a mean VAS score of 33.52 ± 14.30 mm at 1 month, which was non-inferior to control cohort. PHN occurred in 12.5% of US cohort and 11.1% of FL cohort at 3 months after rash onset (p = 0.796). Trends in EQ-5D scores improved similarly between cohorts over time (all p > 0.05). US approach was associated with wider anesthetic dermatomes (p = 0.031), shorter procedure times (p < 0.001) and lower radiation exposure (p < 0.001). No serious adverse events were observed in either cohort.Conclusions US-guided lumbar TFEI was non-inferior to FL procedures. Its unique benefits supported its use in clinical routine practice.
Source: Pain Management
Authors: Xiuhua Li, Liangliang He, Shuyue Zheng
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7124991072