Comparison of Transforaminal Epidural Steroid Injection and Lumbar/Caudal Epidural Steroid Injection for the Treatment of Lumbosacral Radiculopathy

요천추부 신경근병증의 치료를 위한 경추간공 경막외 스테로이드 주입과 요추 및 미추 경막외 스테로이드 주입의 비교

  • Jung, Sun Sop (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Lee, Won Hyung (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University)
  • 정선섭 (충남대학교 의과대학 마취통증의학교실) ;
  • 이원형 (충남대학교 의과대학 마취통증의학교실)
  • Received : 2005.03.25
  • Accepted : 2005.05.16
  • Published : 2005.06.30

Abstract

Background: An epidural steroid injection (ESI) is usually used for the treatment of low back pain with radiculopathy. An ESI can be performed by two procedures: I) a lumbar or caudal epidural steroid injection and II) a transforaminal epidural steroid injection. Methods: Ninety-three patients, who had undergone transforaminal epidural steroid injection (Group II), and either a lumbar or caudal epidural steroid injection (Group I), were retrospectively studied. The authors assessed the pain, walking, standing improvement and side effects after each procedure, which were evaluated as being very good, good, fair or poor. Data were collected from the patients medical records and analyzed using the chi-squared test. P < 0.05 was considered significant. Results: There were no statistically significant differences in the pain, walking, standing improvement and side effects between the two groups. However, there was a statistically significant difference in the pain improvement following transforaminal epidural steroid injection in those not effectively responding to an initial lumbar or caudal epidural block in Group II. Conclusions: A transforaminal epidural steroid injection is a useful alternative to a lumbar or caudal epidural steroid injection for low back pain with radiculopathy.

Keywords

References

  1. White AH, Derby R, Wynne G: Epidural injections for the diagnosis and treatment of low back pain. Spine 1980; 5: 78-83.
  2. Johansson A, Hao J, Sjolund B: Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand 1990; 34: 335-8.
  3. Benzon HT: Epidural steroids. In: pain medicine, a comprehensive review. 1st Edited by Raj PR. St. Louis, Mosby-Year Book. 1996, pp 259-64.
  4. Miklavz Erjaved: Epidural steroids for low back pain. In: Bonica's Management of Pain. 3rd ed. Edited by Loeser JD: Philadelphia, Lippincott Williams & Wilkins. 2001, pp 1557-63.
  5. Rydevik B, Myers RR, Powell HC: Pressure increase in the dorsal root ganglion following mechanical compression. Spine 1989; 14: 574-6.
  6. Boden SD, Davis DO, Dina TS, Patronas NJ, Wissel SW: Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation. J Bone Joint Surg 1990; 72A: 403-8.
  7. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N: High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 1990; 15: 674-8.
  8. Lievre JA, Michel BH, Attali P: L'ingection transsacree: Etude clinique et radiologique. Bull Soc Med Hosp 1957; 73: 1110-8.
  9. Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF: The role of steroids and their effects on phospholipase A2. An animal model of radiculopathy. Spine 1998; 23: 1191-6. https://doi.org/10.1097/00007632-199806010-00001
  10. Warfield CA: Principles and practice of pain management. New York, McGraw-Hill. 1983, pp 401-12.
  11. Cho SJ, Yoon YJ, Lee IB: The effect of single epidural triamcinolone injection on the blood ACTH and cortisol level. Korean J Anesthesiol 1997; 33: 692-6.
  12. Delport EG, Cucuzzella AR, Marley JK, Pruitt CM, Fisher JR: Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil 2004; 85: 479-84.
  13. Valat JP, Giraudeau B, Rozenberg S, Goupille P, Bourgeois P, Micheau-Beaugendre V, et al: Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. Ann Rheum Dis 2003; 62: 639-43.
  14. Loy TT: Epidural steroid injection for sciatica: An analysis of 52 consecutive cases with measurements and the whisrle test. J Orthop Surg 2000; 8: 39-44.
  15. Wang JC, Lin E, Brodke DS, Youssef JA: Epidural injections for the treatment of symptomatic lumbar herniated discs. J Spinal Disord Tech 2002; 15: 269-72.
  16. Papagelopoulos PJ, Petrou HG, Triantafyllidis PG, Vlamis JA, Psomas-Pasalis M, Korres DS, et al: Treatment of lumbosacral radicular pain with epidural steroid injections. Orthopedics 2001; 24: 145-9.
  17. Rozenberg S, Dubourg G, Khalifa P, Paolozzi L, Maheu E, Ravaud P: Efficacy of epidural steroids in low back pain and sciatica. Rev Rhum Engl Ed 1999; 66: 79-85.
  18. Hayashi N, Weinstein IN, Meller ST, Lee HM, Spratt KF, Gebhart GF: The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine 1998; 23: 877-85.
  19. Vad VB, Bhar AL, Lutz GE, Cammisa F: Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002; 27: 11-6.
  20. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Sanelli JT, Freeman ED, et al: Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 2002; 81: 898-905.
  21. Lutz GE, Vad VB, Wisneski RJ: Fluoroscopic transforaminal lumbar epidural steroids: an outcome srudy. Arch Phys Med Rehabil 1998; 79: 1362-6.
  22. Amirdelfan K, Krames E: Randomized, prospective, comparative study of efficacy and patient outcome with translaminar vs selective nerve root epidural steroid injection. Pain Med 2000; 1: 201.
  23. Murphy RW: Nerve roots and spinal nerves in degeneraive disk disease. Clin Orthop 1977; 129: 46-60.
  24. Ryan MD, Talor TK: Managemenr of lumbar nerve root pain by intrathecal and epidural injections of depot methylprednisolone acetate. Med J Ausr 1981; 2: 532-4.
  25. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK: Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000; 81: 1045-50.
  26. Beranan AT, Garbarino JL Jr, Fisher SM, Bosacco SJ: The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain. Clin Orthop 1984; 188: 144-51.
  27. Link SC, el-Khoury GY, Guilford WB: Percutaneous epidural and nerve root block and percutaneous lumbar sympatholysis. Radiol Clin North Am 1998; 36: 509-21.
  28. Nelson D: Dangers from methylprednisolone acetate therapy by intraspinal injection. Arch Neurol 1988; 45: 804-6.
  29. Gilman AG, Ruddon RW, Limbird LE: The pharmacological basis of therapeutics. 9th ed. New York, McGraw-Hill. 1996, pp 1476-7.
  30. Benzone HT: Epidural sreroid injections for low back pain and lumbosacral radiculopathy. Pain 1986; 24: 277-95.