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

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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Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation

Pain Medicine ◽

10.1111/pme.12450 ◽

2014 ◽

Vol 15 (7) ◽

pp. 1100-1108 ◽

Cited By ~ 11

Author(s):

Hans van Helvoirt ◽

Adri T. Apeldoorn ◽

Raymond W. Ostelo ◽

Dirk L. Knol ◽

Mark P. Arts ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Diagnosis And Therapy ◽

Epidural Steroid

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Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

Canadian Journal of Surgery ◽

10.1503/cjs.014611 ◽

2013 ◽

Vol 56 (2) ◽

pp. 89-96 ◽

Cited By ~ 20

Author(s):

Neil Manson ◽

Melissa McKeon ◽

Edward Abraham

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Case Series ◽

Retrospective Case ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Retrospective Case Series ◽

Epidural Steroid

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Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

The Bone & Joint Journal ◽

10.1302/0301-620x.100b10.bjj-2018-0461.r1 ◽

2018 ◽

Vol 100-B (10) ◽

pp. 1364-1371 ◽

Cited By ~ 4

Author(s):

H. Joswig ◽

A. Neff ◽

C. Ruppert ◽

G. Hildebrandt ◽

M. N. Stienen

Keyword(s):

Functional Outcome ◽

Disc Herniation ◽

Radicular Pain ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Arm Pain ◽

One Year ◽

Epidural Steroid

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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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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Follow-up of at least five years after lumbar transforaminal epidural steroid injection for radicular pain due to lumbar disc herniation

Annals of Palliative Medicine ◽

10.21037/apm.2020.01.05 ◽

2020 ◽

Vol 9 (1) ◽

pp. 116-118 ◽

Cited By ~ 2

Author(s):

Seung Hwa Jang ◽

Min Cheol Chang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Steroid Injection ◽

Lumbar Disc ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

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Lumbar Retrodiscal Versus Post-Ganglionic Transforaminal Epidural Steroid Injection for the Treatment of Lumbar Intervertebral Disc Herniations

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/353 ◽

2011 ◽

Vol 4;14 (4;7) ◽

pp. 353-360

Author(s):

Hahck Soo Park

Keyword(s):

Pain Score ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Steroid Injection ◽

Lumbar Disc ◽

Radicular Pain ◽

Epidural Steroid Injection ◽

Vas Score ◽

Classic Approach ◽

Epidural Steroid

Background: Lumbar transforaminal epidural steroid injections (TFESIs) are procedures often utilized in the treatment of radicular pain. TFESIs with a preganglionic approach have been reported to be more effective than TFESIs performed using a classic approach. However, it is unknown whether TFESIs using a retrodiscal approach are as effective as other approaches. Objective: To investigate the effect of an epidural steroid injection (ESI) on radicular pain, we conducted a randomized, controlled trial comparing a retrodiscal approach with a classic approach to treat lumbar disc herniation. Design: A case control study. Methods: Forty patients were randomized to receive lumbar TFESIs with either a retrodiscal approach (n=20) or with a classic approach (n=20). Measurements were taken before as well as 4 and 8 weeks after treatment using a visual analog scale (VAS) score, Patient Satisfaction Index (PSI) and the Roland 5-point pain score. Results: In the retrodiscal group, there was a statistically significant improvement in the VAS score after injection compared to baseline. In the classic group, there was a statistically significant improvement in the VAS score after injection compared to baseline. There was no statistically significant difference in the VAS score, PSI, or the Roland 5-point pain score between those treated with a retrodiscal approache and those treated with a classic approach. Limitations: Secondary outcomes were not measured and the study did not include a midor long-term follow-up period. Conclusion: In this study, TFESIs performed using a retrodiscal or classic approach had similar effects on radicular pain. The classic and the retrodiscal transforaminal steroid injection resulted in equivalent pain relief. . Key words: Corticosteroids, lumbar disc herniation, radicular pain, retrodiscal, transforaminal epidural injection

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