A study of transforaminal epidural steroid injections in patients with lumber disc herniation

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

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The effectiveness of transforaminal epidural steroid injections on radicular pain, functionality, psychological status and sleep quality in patients with lumbar disc herniation

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-150438 ◽

2017 ◽

Vol 30 (2) ◽

pp. 265-270 ◽

Cited By ~ 2

Author(s):

Mustafa Akif Sariyildiz ◽

İbrahim Batmaz ◽

Levent Yazmalar ◽

Mehmet Güneş ◽

Yahya Turan

Keyword(s):

Sleep Quality ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Radicular Pain ◽

Psychological Status ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Epidural Steroid

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Are Foraminal Stenosis Severity and Herniation Level Associated with the Treatment Success of Cervical Interlaminar Epidural Steroid Injection?

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/325 ◽

2020 ◽

Vol 3;23 (6;3) ◽

pp. 325-332

Author(s):

Ipek Saadet Edipoglu

Keyword(s):

Disc Herniation ◽

Treatment Success ◽

Radicular Pain ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Foraminal Stenosis ◽

Spinal Level ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Epidural Steroid

Background: Foraminal stenosis, defined as a narrowing of the cervical neural foramen, is one of the most common causes of upper extremity radicular pain. Objectives: The aim of our study was to determine the effects of the severity of neural foraminal stenosis and spinal herniation level on treatment success in patients treated with interlaminar epidural steroid injections (ILESI) due to cervical disc herniation-related radiculopathy and their possible predictive roles. Study Design: A retrospective assessment. Setting: A university hospital interventional pain management center. Methods: We performed our study between August 2017 and February 2019, retrospectively. All patients’ demographic characteristics, clinical and demographic data, including pain scores before and after cervical ILESI in the first hour, third week, and third month follow-ups, presence of motor deficits, symptom side, symptom duration before cervical ILESI, and whether there was progression to surgery in the 3-month period after injection, were collected. Results: We evaluated 61 patients in the final analysis. When the spinal herniation levels and foraminal stenosis grades were compared, there was a significant difference between the groups (P = 0.003, P = 0.005). We reported significant correlations between foraminal stenosis grade (odds ratio [OR], –0.425, P = 0.038) and spinal herniation level (OR, –0.925, P = 0.001) and treatment success. Limitations: Our study’s design was retrospective. Conclusions: Cervical ILESI is a reliable treatment option that provides a significant reduction in pain of patients with cervical radiculopathy. However, the success of ILESI treatment may be negatively affected in these patients in the presence of high spinal level cervical disc herniation and severe foraminal stenosis. Therefore considering these 2 parameters in predicting the patient population who will benefit from cervical ILESI is of importance in terms of decreasing potential complications. Key words: Interlaminar epidural steroid injections, foraminal stenosis, spinal level, cervical disc herniation, radicular pain

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Evaluation of therapeutic efficacy of epidural steroid injections in lumbar spine with patients of chronic low back pain

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174717 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1218

Author(s):

Saket Jati ◽

Mohammad Danish ◽

Tanveer Sheikh ◽

Ajay Varun

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Disc Herniation ◽

Chronic Low Back Pain ◽

Therapeutic Efficacy ◽

Low Back ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Epidural Steroid

Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in managing chronic low back pain (LBP) along with surgical intervention. Cost effectiveness and affordability has become the cornerstone of evidence-based medicine, and has an influence on coverage decisions, especially in developing countries such as India. LBP is a common problem. The aim of this study was to find the therapeutic efficacy of epidural steroid injections (ESIs) in chronic LBP.Methods: 50 patients presenting with LBP with or without radiculopathy treated with ESIs were prospectively followed for average duration of 12 months.Results: Fifty patients were included in this study with average age 51.02±7.1, out of these 26 (52%) were males and 24 (48%) females. Significant pain relief (>50%) was demonstrated in 43 (71%) of patients and functional status improvement was demonstrated by a reduction of 40% in Oswestry disability index (ODI) score in 49 (81%) patients.Conclusions: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.

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Efficacy of epidural injection of steroid in treatment of lumber disc prolapse: article review

Muthanna Medical Journal ◽

10.52113/1/2410-4590/2021-10-19 ◽

2021 ◽

Vol 8 (1) ◽

pp. 10-19

Author(s):

Musaed hekmat AL-Dahhan

Keyword(s):

Lower Extremity ◽

Disc Herniation ◽

Epidural Injection ◽

Low Back ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Lower Extremity Pain ◽

Epidural Steroid ◽

Caudal Epidural ◽

Corticosteroid Injections

"Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. To describe the indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural corticosteroid injections. Interventions: Three reviewers with formal training and certification in evidence-based medicine searched the literature on non–image guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. A systematic literature search was performed, in the Medline Case reports and retrospective and prospective studies were extensively reviewed to provide detailed descriptions of the clinical features of lumbar and caudal epidural corticosteroid injections. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE , and manual searches of bibliographies of known primary and review articles. Epidural corticosteroid injections are commonly requested treatments for patients with various low-back or lower-extremity pain syndromes (or both). Most of the reports on the use of this type of treatment are retrospective and noncontrolled. These studies indicate benefit; however, the prospective controlled studies provide varied results about the efficacy of lumbar and caudal epidural corticosteroid injections. In conclusions: In patients with lumbar radicular pain secondary to disc herniation or neurogenic claudication due to spinal stenosis, interlaminar epidural steroid injections appear to have clinical effectiveness limited to short-term pain relief. Therefore, in a contemporary medical practice, these procedures should be restricted to the rare settings where fluoroscopy is not available."

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The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.k.00341 ◽

2012 ◽

Vol 94 (15) ◽

pp. 1353-1358 ◽

Cited By ~ 41

Author(s):

Kristen Radcliff ◽

Alan Hilibrand ◽

Jon D Lurie ◽

Tor D Tosteson ◽

Lawrence Delasotta ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Epidural Steroid ◽

The Impact

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Study on the functional outcome of fluoroscopically guided transforaminal epidural steroid injections in patients suffering from lumbar disc herniation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171910 ◽

2017 ◽

Vol 3 (3) ◽

pp. 607

Author(s):

S. Natarajan ◽

Anjan Venkataraman Krishnamurthy ◽

R. Kalanithi ◽

M. D. Ilavarasan

Keyword(s):

Functional Outcome ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Short Term ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Vas Score ◽

Epidural Steroid

Background: Intervertebral disc herniation of the lumbar region is one of the common causes of acute low back ache and lower extremity pain. While multiple treatment modalities exist, the efficacy of the usage of a transforaminal steroid injection as a tool to either alleviate pain or delay surgery needs to be further evaluated. The aim of this study is to determine the functional outcome of patients suffering from lumbar disc herniation treated with fluroscopically-guided transforaminal epidural steroid injections.Methods: This is a prospective case study in which total of 43 patients were included in the study dating between August 2014 and July 2015. These patients were evaluated and identified with lumbar disc herniation, confirmed with a magnetic resonance imaging prior to the procedure. A pre-injection VAS score was taken. These patients were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. They were then evaluated during follow up at 2 weeks, 6 weeks, 12 weeks, and 6 months. Their pain outcome was evaluated using the VAS (visual analog scale) scores and functional outcome was evaluated using Oswestry disability index (ODI).Results: All patients showed significant improvement in the VAS score during their regular follow up when compared to their pre injection levels. Patient satisfaction was the high at 2 weeks post operatively slightly declining over time. 3 patients underwent surgery during the follow up period. The ODI scores also showed significant improvements when compared to the pre injection scores at all follow up periodsConclusions: TFESI provides significant short-term pain relief in patients suffering from a single level lumbar herniated disc and is a viable, effective short-term analgesic tool to address pain and may retard an early surgical intervention.

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