Abstract
Back pain is the leading cause of disability globally and results in a substantial medical and economic burden. Epidural steroid injections (ESIs) have been widely used as a treatment for back pain with radiculopathy of various etiologies. Ultrasound guidance (UG) for delivering ESIs can reduce costs and facilitate the procedure in resource-limited settings compared to the current standard technique of using fluoroscopic guidance (FG). This scoping review aimed to compare the clinical outcomes between UG and FG ESIs in the treatment of radicular pain. Systematic searches of Embase, Ovid Medline, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), CDSR (Cochrane Database of Systematic Reviews), and ClinicalTrials.gov were conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews) guidelines. Randomized controlled trials (RCTs) and comparative observational studies investigating the outcomes between UG and FG ESIs in the treatment of radicular pain were included. The risk of bias for included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. From 1,659 potentially relevant publications, eight studies (five RCTs and three retrospective comparative studies) were included. Five of the studies were conducted in the Republic of Korea, one in China, one in India, and one in Egypt. All studies reported no significant difference between UG and FG ESIs in success rate, pain index, and postoperative disability (p > 0.05). One study reported increased intravascular injections in the FG group, but this did not reach statistical significance (p > 0.05). One study reported decreased needle-placement time in the UG group (p < 0.001). One study reported decreased total operation time in the UG group (p < 0.05). Overall, treatment outcomes and adverse events profile are comparable between UG and FG ESIs for radicular pain. UG ESIs reduce costs, minimize radiation exposure, facilitate vessel identification, prevent injury, and potentially save intraoperative time while offering the same benefits as FG injections. Future studies should focus on long-term outcomes, cost-effectiveness, and the impact of UG ESIs on patient satisfaction and quality of life.