scholarly journals The Efficacy of Transforaminal Epidural Steroid Injection by the Conventional Technique in FarLateral Herniation of Lumbar Disc

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. 415-420
Author(s):  
Joon-Hee Park
Keyword(s):  
Oswestry Disability Index ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Conventional Technique ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Significant Difference ◽  
Transforaminal Epidural Steroid Injection ◽  
Far Lateral ◽  
Epidural Steroid

Background: Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD. Objective: To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients. Study Design: A retrospective design. Methods: There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections. Results: There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups. Limitations: A relatively small numbers of cases were included in the FHLD group. Conclusion: The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients. Key words: Far lateral herniation of lumbar disc, intraspinal herniation of lumbar disc, transforaminal epidural steroid injection, safe triangle, herniated lumbar disc, visual analog pain scale, Oswestry disability index, radiculopathy

Modification of the Cervical Transforaminal Epidural Steroid Injection Technique Based Upon the Anatomic Angle of the Superior Articular Process on MRI

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2090-2099
Author(s):  
David Levi ◽  
Scott Horn ◽  
Jestine Murphy ◽  
Matt Smuck ◽  
Josh Levin
Keyword(s):  
Steroid Injection ◽  
Flow Patterns ◽  
Conventional Technique ◽  
Conventional Approach ◽  
Epidural Steroid Injection ◽  
Injection Technique ◽  
Articular Process ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid ◽  
Contrast Flow

Abstract Objective A modification of the conventional technique for cervical transforaminal epidural steroid injection (CTFESI) has been developed. This technique may, theoretically, decrease the likelihood of the needle encountering the vertebral artery and spinal nerve. The approach uses angle measurements of the superior articular process ventral surface from the patient’s axial MRI as a guide for fluoroscopic set-up and needle trajectory. This report aims to compare contrast flow patterns of the modified approach with those of the conventional technique. Design Retrospective chart review and prospective blinded analysis of contrast flow patterns. Setting. Outpatient interventional physiatry practice. Methods A retrospective blinded qualitative review of fluoroscopic images was performed to compare contrast flow patterns of CTFESIs performed using the modified approach with those using the conventional technique. A detailed description of the modified approach is provided in this report. Results Ninety-seven CTFESI procedures were used for flow analysis. The modified approach resulted in a statistically significant greater percentage of injections with epidural flow: 69% [95% CI = 57–82%] modified approach vs. 42% [95% CI = 28–56%] conventional approach. The modified technique also showed a statistically significant higher percent of injections categorized as having an ideal flow pattern, that of predominate epidural and/or intraforaminal flow: 65% [95% CI = 52–78%] vs. 27% [95% CI = 14–40%]. Conclusions A modification of the conventional CTFESI technique, developed for the purpose of improved safety, may provide superior contrast flow patterns when compared to the conventional approach.

scholarly journals Transforaminal Epidural Steroid Injection Combined with Radio Frequency for the Treatment of Lumbar Disc Herniation: A 2-year Follow-up

2020 ◽  
Author(s):  
Wenbo Wei ◽  
Shajie Dang ◽  
Ling Wei ◽  
Tian Liu ◽  
Jue Wang
Keyword(s):  
Radio Frequency ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Hospitalization Time ◽  
Post Operation ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Objective: To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH). Methods: A total of 230 patients participated in the study: TFESI (Group T, n=110), TFESI combined with RF (Group TR, n=120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Hospitalization time, operation time, complications, and recurrence were compared between the two groups.Results: The VAS and ODI at each observation point of the post-operation were significantly decreased compared with the pre-operation in both groups (P < 0.05). There was no statistically different of VAS and ODI between the two groups at 1 and 3 months of the post-operation (P > 0.05). However, The VAS and ODI scores in Group TR were significantly lower than that in Group T at 6, 12 and 24 months of the post-operation (P < 0.05). The GPE in group TR was high in the early days, while that at 1 and 3 month after treatment was significantly higher than that in group T (P < 0.05). The recurrence rate in Group TR was lower than that in Group T (P = 0.002). There was no significant difference of hospitalization time, complications, VAS and ODI score at the pre-operation between the two groups (P > 0.05).Conclusion: These findings suggest that TFESI combined with RF could effectively improve the pain and function, and had a long-term satisfactory effect for the treatment of LDH.

scholarly journals Transforaminal epidural steroid injection combined with radio frequency for the treatment of lumbar disc herniation: a 2-year follow-up

2021 ◽  
Author(s):  
Wenbo Wei ◽  
Shajie Dang ◽  
Ling Wei ◽  
Tian Liu ◽  
Jue Wang
Keyword(s):  
Radio Frequency ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Hospitalization Time ◽  
Post Operation ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Abstract Objective: To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH). Methods: A total of 230 patients participated in the study: TFESI (Group T, n=110), TFESI combined with RF (Group TR, n=120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Hospitalization time, treatment time, complications, and recurrence were compared between the two groups.Results: The VAS and ODI at each observation point of the post-operation were significantly decreased compared with the pre-operation in both groups (P < 0.05). There was no statistically difference of VAS and ODI between the two groups at 1 and 3 months of the post-operation (P > 0.05). However, The VAS and ODI scores in Group TR were significantly lower than that in Group T at 6, 12 and 24 months of the post-operation (P < 0.05). The GPE in group TR was high in the early days, while that at 1 and 3 months after treatment was significantly higher than that in group T (P < 0.05). The recurrence rate in Group TR was lower than that in Group T (P = 0.002). There was no significant difference in hospitalization time, complications, VAS and ODI score at the pre-operation between the two groups (P > 0.05).Conclusion: These findings suggest that TFESI combined with RF could effectively improve the pain and function, and had a long-term satisfactory effect for the treatment of LDH.

scholarly journals Paraplegia after transforaminal epidural steroid injection in a patient with severe lumbar disc herniation - A case report -

2021 ◽  
Vol 16 (1) ◽  
pp. 96-102
Author(s):  
Seok Ho Jeon ◽  
Won Jang ◽  
Sun-Hee Kim ◽  
Yong-Hyun Cho ◽  
Hyun Seok Lee ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Steroid Injection ◽  
Treatment Plan ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Epidural Steroid Injection ◽  
Correct Treatment ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Background: Transforaminal epidural steroid injection (TFESI) is a conservative treatment for patients with lumbar disc herniation (LDH). However, there are reports of various complications that can occur after TFESI; among these, paraplegia is a serious complication. Case: A 70-year-old woman who was unable to lie supine due to low back pain exacerbation during back extension underwent TFESI. After injection, there was pain relief and the patient was able to lie supine; however, paraplegia developed immediately. Magnetic resonance imaging confirmed cauda equina syndrome (CES) due to nerve compression from L1–2 LDH. We determined that the patient's LDH was already severe enough to be considered CES and that the TFESI procedure performed without an accurate understanding of the patient's condition aggravated the disease. Conclusions: It is important to accurately determine the cause of pain and disease state of a patient to establish a correct treatment plan before TFESI is performed.

scholarly journals Clinical effectiveness of selective nerve root block in lumbar radiculopathy

2021 ◽  
Author(s):  
Atul Singh ◽  
Tanmay Mallick ◽  
Sarvesh Kumar Singh ◽  
Ajay Abrol
Keyword(s):  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Functional Improvement ◽  
Post Injection ◽  
Success Rates ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

<p class="abstract"><strong>Background:</strong> Epidural steroid injections (ESIs) have been used as an adjunct in the treatment of sciatica. Since the early reports, success rates ranging from 18% to 90% (average, 67%) have been documented. However, the efficacy of ESI has lasted, on the average, less than 3 months.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at Abrol medical centre, Punjab from June 2019 to June 2020. One hundred patients with back pain documented with lumbar disc disease treated initially with rest, analgesics and physiotherapy for at least six weeks were included in the study and treated with transforaminal epidural steroid injection. The protocol of the study was approved by ethical committee. Patients to be participated in this study were documented. Patients with lumbar disc disease were given transforaminal epidural steroid injection in Orthopaedics operation theatre of our institute. Informed and written consent were obtained as per ethical committee guidelines.<strong></strong></p><p class="abstract"><strong>Results:</strong> Pre-procedure Roland Morris disability mean score was 17.54 and it got reduced to 5.57 by 4<sup>th</sup> day immediately post injection, was 6.44 by 6 weeks, by 3<sup>rd</sup> month 7.1 and by end of 6 months it was 8.34. Improvement in score on 4<sup>th</sup> day post injection was 68.24 percent which is considered significant and successful.</p><p class="abstract"><strong>Conclusions:</strong> Transforaminal epidural steroid treatment better medication for pain relief, patient satisfaction, disability improvement and functional improvement.</p>

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