Outcome of transforaminal epidural steroid injection for lumbar radiculopathy: initial three-year experience at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Nepal (original) (raw)
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Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy
Hong Kong Medical Journal, 2015
Main outcome measures: Patients' immediate response, response duration, proportion of patients requiring surgery, and risk factors affecting the responses to transforaminal epidural steroid injection for lumbar radiculopathy. Results: Of the 232 patients, 218 (94.0%) had a single level of radiculopathy and 14 (6.0%) had multiple levels. L5 was the most commonly affected level. The immediate response rate to transforaminal epidural steroid injection was 80.2% in 186 patients with clinically diagnosed lumbar radiculopathy and magnetic resonance imaging of the lumbar spine suggesting nerve root compression. Of patients with single-level radiculopathy and multiple-level radiculopathy, 175 (80.3%) and 11 (78.6%) expressed an immediate response to transforaminal epidural steroid injection, respectively. The analgesic effect lasted for 1 to <3 weeks in 35 (15.1%) patients, for 3 to 12 weeks in 37 (15.9%) patients, and for more than 12 weeks in 92 (39.7%) patients. Of the 232
Anesthesiology and Pain Medicine, 2015
Background: Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF. Objectives: This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain. Patients and Methods: This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0-10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI). Results: Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67-90.5%) of patients in PIL group and 74.2% (95% CI: 62.4-89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients. Conclusions: The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration.
European Spine Journal, 2012
Introduction Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs. Moreover, a few neurological adverse events have been reported recently. Methods A literature search of systematic reviews analysing the effectiveness and complications of ESIs was carried out. The scientific quality of the reviews was assessed using the validated index of Oxman and Guyatt. We relied on data abstraction and quality ratings of the placebo-controlled trials as reported by high-quality systematic reviews. Results Two types of systematic reviews were found. The Cochrane high-quality systematic reviews combining the three approaches and different pathologies were predominantly non-conclusive. The second type of review, emanating from the US Evidence-based Practice Centers, distinguishing between the routes of administration and between the principal pathologies found a moderate shortterm benefit of ESIs versus placebo in patients with disc herniation and radiculitis, in keeping with the clinical experience. ESIs are generally well tolerated and most complications are related to technical problems. Cases of paraplegia, complicating the foraminal route and related to the violation of a radiculomedullary artery, have been recently reported. They are predominantly observed in previously operated patients. Conclusions Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury. Keywords Epidural Á Steroid injection Á Radiculopathy Á Discal herniation Á Radiculitis Á Lumbar canal stenosis Abbreviations ESI Epidural steroid injection ODI Oswestry disability index RCT Randomized controlled trial LBP Low-back pain NA Not available
A prospective study on the role of epidural steroidal injections in backache with radiculopathy
International Journal of Clinical Trials, 2021
Background: Low backache (LBA) with lumbosacral radiculopathy is the most challenging musculoskeletal problem for its therapeutic management and cause of LBA with radiculopathy is a prolapsed disc. Epidural steroidal injection (ESI) are used in the management of the patients with sub-acute or chronic LBA with radiculopathy, not responding to conservative treatment. The most common cause being, lumbar disc disease, is confirmed via magnetic resonance imaging having high sensitivity and specificity. The aim of study was to check the efficacy of ESI in patients of sub-acute or chronic low backache with radiculopathy due to herniated disc.Methods: The study was conducted over 200 patients reporting our OPD during Dec 2017- Feb 2018 with complaints of LBA with radiculopathy, not responding to conservative treatment. Maximum of 3 ESI were given with two weeks of interval in between. The patients were assessed using VAS scoring system.Results: 77.5% patients got improvement in symptoms, a...
INTRODUCTION Lower back pain is one of the most common after headache. Along with lower back pain, radiating pain or radicular pain down to the lower limb is a widespread clinical problem that need be addressed precisely. Almost 30% of patients who develop lower back pain usually will suffer from radicular pain at one point of time. More than 50% of the patients with radiculopathy and sciatica have disturbances in performing activities of daily living and difficulty at work, leading to loss of work hours. The most common cause of lumbosacral radiculopathy in all the age group is intervertebral disc prolapse, and almost 10% to 15% of these patients eventually may require surgery due to their persistent symptoms, interference with daily activity, and neurological deficit. 1 However, majority of patients with lumbosacral radiculopathy have uneventful recovery with conservative management. The conservative management is wide and typically includes bed rest during acute ABSTRACT Background: Low back pain is a common entity with a lifetime prevalence of 65 to 80 percent in general population, and usually disrupts work, social activity and activity of daily living. The purpose of our study was to evaluate the results of interlaminar epidural steroid injection versus caudal steroid injection for patients of lower back pain with radiculopathy, due to disc prolapse or disc degeneration in terms of pain relief and complications. Methods: A total of 272 subjects having low back pain with radicular leg pain and MRI evidence of single or double level disc prolapse were chosen. Out of 272, patients were randomly assigned to two group; the first group having 131 patients and second group having 141 patients. The first group received caudal steroid injection, and second group received interlaminar epidural steroid under fluoroscopy control. Follow up for both groups was at 1 week, 6 weeks, and 12 weeks. Results: The change in pain scores were rated as mild, moderate and excellent. The interlaminar epidural steroid injection fared excellent in earlier follow up, getting to moderate at 12 weeks' time. The caudal steroid injection produced moderate relief in early phase at 12 weeks' time. Conclusions: The caudal steroid injection is cost effective, easy to administer and is having much less complications as compared to interlaminar steroid injection. Both these procedures are safe, well tolerated procedures, and can be performed as outpatient procedures
WILEY, 2024
Background: Transforaminal and caudal epidural injections are two methods of steroid injection in lumbar radiculopathy. Using a targeted catheter with the possibility of accessing the involved spinal roots and steroid administration selectively next to them during the caudal procedure may achieve the benefits of both transforaminal and caudal procedures. The aim of this study was to investigate the clinical effects and physical examinations of transforaminal steroid injection compared to caudal through a targeted catheter in lumbar radiculopathy. Methods: Fifty patients with lumbar radiculopathy candidates for epidural steroid injection were divided into transforaminal (T) and caudal (C) groups. Steroid injection under fluoroscopic guidance was performed in group T with the transforaminal method and in group C with the caudal method using a targeted catheter for each involved spinal nerve root. Pain intensity visual analog scale (VAS), Oswestry Disability Index (ODI), daily analgesic consumption, and physical examinations on four follow-ups (before injection, second week, first and third month) were evaluated. Results: Pain score (VAS) and functional disability index (ODI) were similar in both groups, and there was no significant difference between the two groups (p > 0.05). The positive Lasègue test was significantly higher in the caudal group than in the transforaminal group only in the third month (p < 0.05). Other physical examinations in both groups did not have significant differences in all the follow-ups. Moreover, there was no difference in the amount of analgesic consumption in the two groups. No complications were observed in both groups. Conclusion: This study showed that transforaminal and caudal steroid injection (with a targeted catheter) in patients with lumbar radiculopathy had similar effects in controlling pain and improving functional disability of patients in the short term. Cases of recurrence of positive Lasègue test in physical examinations in the long term (third month) in the caudal group may indicate the preference of the transforaminal approach. Trial Registration: Iranian Registry of Clinical Trials (IRCT) number: IRCT20111102007984N31 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Skeletal Radiology
Objective To assess the predictive value of immediate pain-relief after CT-guided transforaminal epidural steroid injection (TFESI) including local anesthetics for longer-term pain relief and patients’ global impression of change (PGIC) after 4 weeks. Materials and methods One hundred ninety-three patients (age 55.4 ± 14.9) with single-level discogenic lumbar radiculopathy and subsequent TFESI were included. Pain scores were recorded before (NRS0), 15 min (NRS15min), and 4 weeks (NRS4w) after treatment using a numerical-rating-scale (NRS; 0, no pain; 10, intolerable pain). Additionally, the PGIC was assessed after 4 weeks. Two fellowship-trained musculoskeletal radiologists evaluated nerve compression of the injected level and contrast dispersion. Spearman’s rank and point-biserial correlation were applied to assess associations between outcome variables and demographics/imaging findings. A p-value < 0.05 was considered to be statistically significant. Results There was a signifi...
Pain physician
Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. The available literature ...