Effectiveness of Epidural Steroid Injection Depending on Discoradicular Contact: A Prospective Randomized Trial (original) (raw)
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Annals of International medical and Dental Research, 2017
It is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. radiculopathy secondary to disc herniation resolves spontaneously in 23% to 48% of patients, 5% to 15% of patients undergo surgery, resulting in a strain on the health care system and subsequently, the economy. [6-9] Various conservative, nonsurgical modalities for treating lumbar disc herniation or radicular pain exist, including epidural injections. Data from the Spine Patient Outcomes Research Trial (SPORT) evaluation reported the clinical and cost effectiveness of lumbar disc herniation ABSTRACT Background: Transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) are commonly performed procedures for the management of unilateral lumbosacral radicular pain (LSRP) due to intervertebral disc herniations. Unilateral LSRP is thought to originate from inflammation in the proximity of a damaged intervertebral disc or a narrowed neuralforamen that irritates an exiting spinal nerve root. Thus corticosteroids are commonly used to reduce inflammation in the epidural space. The purported advantage of TFESI over ILESI is attributed to enhanced deposition of medication in closest proximity to the pain generators found in the ventral epidural space and hence reaching the targeted pain generators with a smaller dose of medication. Data from multiple studies and systematic reviews of the published data support the utility of TFESI and have shown that lumbar TFESI are effective for reducing pain, improving functionality, preventing spine surgery and for treating radiculopathic pain. Methods: In a prospective study, 60 patients with low back pain were randomly allocated to one of the two groups of 30 patients each. In Group IL(interlaminar approach), with the patient in lateral position, under strict aseptic precautions, 18G Tuohy needle is placed by loss of resistance technique and confirmed using iohexol dye and 80 mg (2 mL) of methyprednisolone with 2 mL of normal saline is injected. In group TF(transforaminal approach), with the patient in prone position, under strict aseptic precautions, 23 G Quinke needle is placed in epidural space under C-arm guidance and confirmed by using Iohexol dye and 80 mg (2 mL) of methyprednisolone with 2 mL of normal saline is injected. Patient monitored for 15 mins after the procedure. Pain relief assessed by using Numerical Rating Scale(NRS), Verbal Rating Scale(VRS), Straight Leg Raising Test(SLRT) etc. Results: In Group IL, NRS decreased from 7.77±1.2 (pre-procedure) to 4.73±1.1 and 4.27±1.5 at the end of 2nd and 3rd week respectively. In Group TF, NRS decreased from 7.8±1.3 (pre-procedure) to 2.77±1.7 and 2.63±1.7 at the end of 2nd and 3rd week respectively. This difference in NRS was statistically significant both at the end of 2nd week and 3rd week with a P value of 0.001 with Group TF having better pain relief. There was no statistically significant difference among the 2 groups with respect to SLRT, improvement in walking tolerance, reduction in analgesic use and reversal of paraesthesia at the end of 3rd week. Conclusion: Epidural steroid injection by transforaminal route provides better subjective pain relief in the short term.
Anesthesia & Analgesia, 2016
Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria. Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months. Results: The pain and ODI scores at baseline and at six months' follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively. Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.
Pain Medicine, 2014
Background. Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation. Objective. This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation. Design. A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain. All subjects received a single level transforaminal epidural steroid injection with either dexamethasone or triamcinolone. Repeat injections were allowed as determined by the blinded physician and subjects. Primary outcomes included: number of injections received, surgical rates, and categorical pain scores at 2 weeks, 3 months, and 6 months. Secondary outcomes included mean Oswestry Disability Index. Results. Both triamcinolone and dexamethasone resulted in statically significant improvements in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The surgical rates were comparable with 14.6% of the dexamethasone group and 18.9% of the bs_bs_banner
Journal of Back and Musculoskeletal Rehabilitation, 2016
Prospective cohort study. BACKGROUND: Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. OBJECTIVE: The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. METHODS: Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. RESULTS: A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.
Turkish Neurosurgery, 2020
AIM: To compare the effect of fluoroscopically guided transforaminal epidural steroid injections on radicular pain in foraminal and paramedian lumbar disc herniations. MATERIAL and METHODS: This study included patients who did not benefit from previous medical treatments or are not suitable for surgery. Transforaminal epidural steroid injections for the treatment of foraminal and paramedian lumbar disc herniation were performed in 370 and 1262 patients, respectively. Every group's preprocedural visual analogue scale (VAS) and 12-week postprocedural VAS scores were recorded, and statistical analysis was performed. The complications noted were also recorded. RESULTS: The preprocedural and postprocedural mean VAS scores for radicular pain in foraminal disc herniation were 67.11 ± 4.28 and 34.78 ± 3.64, respectively. However, the preprocedural and postprocedural mean VAS scores in paramedian disc herniation were 62.16 ± 6.65 and 19.07 ± 4.50, respectively. Statistical analysis of the varying preprocedural and postprocedural VAS scores showed that transforaminal epidural steroid injections were more effective for paramedian disc herniation than for foraminal disc herniation (p<0.05). CONCLUSION: Transforaminal epidural steroid injections were more effective for paramedian lumbar disc herniation than for foraminal disc herniation, 12 weeks after the procedure.
Turkish Neurosurgery, 2018
deficit. Sometimes the pain can be unbearable but the patient does not want surgical intervention. Nerve root compression may stimulate inflammatory processes (14,17), providing a rationale for the use of corticosteroids to inhibit inflammation and alleviate pain. The transforaminal epidural injection of corticosteroids under fluoroscopic guidance delivers high concentrations of therapeutic agents to the site of pathology (5). Appropriately performed transforaminal epidural steroid █ INTRODUCTION R adicular pain is most commonly caused by mechanical compression of the nerve root by lumbar disc herniation or peripheral foraminal stenosis and has considerable economic significance (7). In most cases, the pain stops spontaneously or can be relieved with conservative treatment. However, some lumbar disc herniation cases require surgical intervention because of persistent severe pain or neurological AIM: To compare the outcomes of fluoroscopically guided transforaminal epidural steroid injections between L4-L5 paramedian disc herniation and L5-S1 paramedian disc herniation for the treatment of radicular pain. MATERIAL and METHODS: A total of 593 patients treated by transforaminal epidural steroid injections for the treatment of L4-5 paramedian disc herniation and 504 patients treated by transforaminal epidural steroid injections for the treatment of L5-S1 paramedian disc herniation were included in the study. All the patients were regularly followed up for 12 weeks. Preprocedural Visual Analogue Scale (VAS) scores, 12-week post-procedural VAS scores and complications were recorded. RESULTS: The mean preprocedural and postprocedural VAS scores for L4-5 paramedian disc herniation were 63.09 ± 5.37 and 15.81 ± 3.58, respectively, and the mean preprocedural and postprocedural VAS scores for L5-S1paramedian disc herniation were 61.15 ± 5.45 and 27.06 ± 3.62, respectively, for radicular pain. There was a statistically significant difference between preprocedural and postprocedural VAS scores for L4-5 and L5-S1 paramedian disc herniation (p<0.05). Transforaminal epidural steroid injections for L4-5 paramedian disc herniation were more effective than transforaminal epidural steroid injections for L5-S1 paramedian disc herniation. CONCLUSION: This study showed that transforaminal epidural steroid injections for L4-5 paramedian disc herniation were more effective than transforaminal epidural steroid injections for L5-S1 paramedian disc herniation in the 12-week follow-up period.
Pain physician
Lumbar disc herniation and radiculitis are common elements of low back and lower extremity pain. Among minimally invasive treatments, epidural injections are one of the most commonly performed interventions. However, the literature is mixed about their effectiveness in managing low back and lower extremity pain. In general, individual studies and systematic reviews of epidural steroid injections have been hampered by their study design, baseline differences between treatment groups, inadequate sample sizes, highly controlled settings, lack of validated outcome measures, and the inability to confirm the injectate location because fluoroscopy was not used. A randomized, controlled, double blind, active control trial. A private, interventional pain management practice, specialty referral center in the United States. To assess the effectiveness of fluoroscopically directed caudal epidural injections with local anesthetic with or without steroids in managing chronic low back and lower ex...