DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151455

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

Vipul L. Kuvad

Abstract


Background: Although various studies have evaluated traditional caudal and interlaminar approach for lumbar epidural steroid, I tried to evaluate efficacy of transforaminal approach in this study.

Methods: In twenty five patients with inclusion criteria, I administered periodic injections of methyl prednisolone acetate in combination with 2% xylocaine through transforaminal approach under fluoroscopic guidance. Patients were evaluated and assessed for pain relief, activity level and disability by direct questionnaire before and after the procedure and at final follow up.

Results: Overall Visual numeric score was improved by 60.4%. Overall Roland-Morris score was improved by 73.9%. Average number of injection per patient is 1.7. Three patients required surgery for poor pain relief. Two patients undergone discectomy surgery. One patient opted physiotherapy and refused for surgery.

Conclusion: Transforaminal epidural steroid is a safe, simple, least morbid and cost effective approach for the patients with lumbar disc herniation with radiculopathy.


Keywords


Low back pain, Sciatica, Epidural steroid, Transforaminal epidural steroid

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References


Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988;318:291-300.

Lawrence JS. Disc degeneration: Its frequency and relationship to symptoms. Ann Rheum Dis. 1969;28:121-38.

Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581.

Bush K, Cowan N, Katz DE. The natural history of sciatica with associated disc pathology: A prospective study with clinical and independent radiologic follow-up. Spine. 1992;17:1205-12.

White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low back pain. Spine. 1980;5:78-86.

Bogduk N. Epidural steroids. Spine. 1995;20:845-8.

Carrette S, Leclaire R. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997;336:1634-40.

Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am. 1985;67:63-6.

Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective randomized study. J Bone Joint Surg Am. 2004;86:670-9.

Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000;82:1589-93.

Weiner BK, Fraser RD. Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 1997;79:804-7.

E1-Khouri Ehara S, Weinstein JN, Montgomery WJ, Kathol MH. Epidural steroid injection: a procedure ideally performed with fluoroscopic control. Radiology. 1988;168:554-7.

Stewart HD, Quinnell RC, Dann N. Epidurography in the management of sciatica. Br J Rheumatol. 1987,26:424-29.

Manchikanti L. Transforaminal lumbar epidural steroid injections. Pain Physician. 2000;3:374-98.

Derby R, Bogduk N, Kine G. Precision percutaneous blocking procedures for localizing spinal pain: Part 2. The lumbar neuraxial compartment. Pain Dig. 1993;3:175-88.

Derby R, Kine G, Saal JA, et al. Response to steroid and duration of radicular pain as predictors of surgical outcome. Spine. 1992;17:S176-83.

Kambin P, O’Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop. 1998;347:150-67.

Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in the management of lumbar nerve root compression. BMJ. 1973;2:635-7.

Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nocioceptive C-fibers. Acta Anesthesiol Scand. 1990;34:335-8.

Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar spinal disc herniations. Spine. 1990;15:674-8.

Marshall LL, Trethewie ER, Curtain CC. Chemical radiculitis: A clinical, physiological, and immunological study. Clin Orthop. 1977;129:61-7.

Gamburd RS. The use of selective injections in the lumbar spine. Phys Med Rehabil Clin. 1991;2:79-96.

Renfrew DL, Moore TE, Kathol MH, et al. Correct placement of epidural steroid injections: Fluoroscopic guidance and contrast administration. Am J Neuroradiol. 1991;12:1003-7.

Buttermann GR. Lumbar disc herniation regression after successful epidural steroid injection. J Spinal Disord. 2002;15:469-76.

Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine. 1989;14:431-7.

Lutz GE, Vad VB, Wisneski RJ. Segmental instability: rehabilitation considerations. Semin Spine Surg. 1996;8:1-8.