A Prospective, Observational Study of the Relationship Between Body Mass Index and Depth of the Epidural Space During Lumbar Transforaminal Epidural Steroid Injection

Background: Results of the lumbar transforaminal epidural steroid injection (L-TFESI) used in the treatment of lumbar radiculopathy may be affected by the current psychiatric condition of the patient. Objectives: The study aimed to assess the effects of pretreatment comorbid psychiatric conditions on patient outcomes in patients with lumbar disc herniation and radiculopathy. Study Design: The study used a prospective-observational study design. Setting: Research was conducted at a university hospital international pain management center. Methods: In this observational study, 103 patients were included. All patients were evaluated with the Hospital Anxiety and Depression scale (HADS) for depression and anxiety levels and the Somatosensory Amplification Scale (SSAS) for somatization levels before the L-TFESI. The treatment results were evaluated with the Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) at baseline, the third week, and the third month. Relative to baseline, a 50% reduction in the NRS was accepted as a successful treatment. Results: HADS-depression, HADS-anxiety, and SSAS levels were similar between the patients with successful treatment outcome and the patients in whom treatment failed. However, there were negative correlations between percent reduction in the NRS and the HADS-depression levels at 3 weeks (r = -0.182, P = .022) and 3 months (r = -0.204, P = .037). Also, there were positive correlations between patients’ pre-injection ODI scores and both the HADS-anxiety (r = 0.271, P = .001) and SSAS (r = 0.201, P = .013) scores. Limitations: The study was limited by a relatively short-term follow-up period. Conclusions: Although psychiatric conditions affected the pain and disability of patients before and after the L-TFESI, and may have an impact on patient-related outcomes, they should not be a reason to not treat patients or expect a lower chance of success. Key words: Anxiety, depression, disc herniation, low-back pain, lumbar radiculopathy, patientrelated outcomes, somatization, transforaminal epidural steroid injection

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Does the Contrast Dispersion Pattern During Fluoroscopically Guided Cervical Transforaminal Epidural Steroid Injection Predict Short-Term Pain and Functional Outcomes? An Exploratory Analysis of Prospective Cohort Data

Pain Medicine ◽

10.1093/pm/pnaa305 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3350-3359

Author(s):

Aaron Conger ◽

Beau P Sperry ◽

Cole W Cheney ◽

Keith Kuo ◽

Russel Petersen ◽

...

Keyword(s):

Neck Pain ◽

Epidural Space ◽

Functional Outcomes ◽

Steroid Injection ◽

Epidural Steroid Injection ◽

Dispersion Pattern ◽

Arm Pain ◽

Dispersion Patterns ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

Abstract Summary of Background Data No study has evaluated the relationship between contrast dispersion patterns and outcomes after fluoroscopically guided cervical transforaminal epidural steroid injection (CTFESI). Objectives Determine whether contrast dispersion patterns predict pain and functional outcomes after CTFESI. Methods Secondary analysis of data collected during two prospective studies of CTFESI for the treatment of refractory radicular pain. Contrast dispersion patterns visualized by true anteroposterior (AP) projections during CTFESIs were categorized by flow: 1) completely external to the lateral border of the neuroforamen (zone 1); 2) within the neuroforamen but without entry into the lateral epidural space (zone 2); and 3) with extension into the lateral epidural space (zone 3). At baseline and at 1 month post-CTFESI, neck pain, arm pain, and “dominant index pain” (the greater of arm or neck pain) were evaluated using a numeric rating scale (NRS); physical function was assessed using the Five-Item Version of the Neck Disability Index (NDI-5). Results One-month post-CTFESI, neck pain, arm pain, and “dominant index pain” reductions of ≥50% were observed in 39.4% (95% confidence interval [CI], 28.2–51.8), 55.6% (95% CI, 43.0–67.5), and 44.1% (95% CI, 32.7–56.2) of participants, respectively. Regarding “dominant index pain,” 72.7% (95% CI, 40.8–91.2), 39.4% (95% CI, 24.2–57.0), and 37.5% (95% CI, 20.5–58.2) of participants reported ≥50% pain reduction when zone 1, zone 2, and zone 3 contrast flow patterns were observed. Contrast dispersion zone was not significantly associated with subgroup differences in neck pain, arm pain, or NDI-5 scores (P>0.05). Conclusion Improvements in pain and function 1 month after treatment with CTFESI did not differ significantly based on the contrast dispersion pattern. Future study is needed to confirm or refute these findings in other procedural settings, in broader patient populations, and with longer-term outcome assessment.

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