To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc.
Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment.
In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00±1.52, 4.29±1.20, 2.64±0.93, 1.43±0.51 and those of FRI were 23.57±3.84, 16.50±3.48, 11.43±2.44, 7.00±2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22±2.05, 4.28±1.67, 2.56±1.04, 1.33±0.49 and those of FRI were 22.00±6.64, 16.22±5.07, 11.56±4.18, 8.06±1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically.
Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.
Citations
Objective: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain.
Method: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection.
Results: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p＜0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p＜0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p＜0.05).
Conclusion: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.
For the management of refractory radicular pain, traditional injection techniques such as transcaudal or translumbar epidural steroid injection may be indicated. This epidural injection, done blindly, may result in improper needle placement. Fluoroscopically guided transforaminal epidural steroid injection and computerized tomography-controlled periganglionic foraminal steroid injection are selective nerve blocks. These procedures are useful for the diagnosis. The advantages of these procedures are precise anatomic location provided by fluoroscope or CT.
Intraforaminal or periganglionic steroid injection is useful in the treatment of radicular pain. Thus we introduce a case of selective epidural steroid injection in a patient with refractory radicular pain.
The purpose of this study was to see whether there were any correlations between the clinical findings and outcomes after the epidural steroid injection(ESI), and to determine which of the clinical findings might be of importance as favorable signs to predict a good result with the ESI.
The present study involves 23 elderly patients(18 females and 5 males) with spinal stenosis. The participants were divided into several subgroups according to the clinical features, such as presenting symptoms, age, duration of symptoms and physical findings. Subjects received the epidural injection of 80 mg Depo-Medrol with 6 ml of 1.5% lidocaine solution. The subjects completed a questionnaire before the ESI, and at three weeks and two months after the ESI respectively. The questionnaire included three scales on symptom severity, physical function, and satisfaction. The visual analogue pain scale was utilized as well.
At three weeks, satisfaction outcomes were encountered in 82.6 percent of the sudjects. Differences in the satisfaction between the subgroups according to the duration of symptoms and abnormal physical findings were statistically significant(P＜0.05). The total scores of symptom severity and physical function had improved from the baseline values(P＜0.0001). However, the score changes in each subgroup, for the duration of symptoms differ statistically same (P＜0.05) as assessed by the visual analogue pain scale. The results at two months were similar to those of at three weeks. Approximately 78.3% of the patients reported the satisfactory results. Although the follow up period was short, the results demonstrated that the epidural steroid injection afforded much improvement in clinical symptom and physical function in elderly patients with the lumbar spinal stenosis. The only significant difference was the satisfaction outcomes in the groups with short duration of symptoms. The determination of persisting outcomes from the ESI would require a long-term follow-up study.
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