Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Transforaminal Epidural Steroid Injection for Lumbosacral Radiculopathy: Preganglionic versus Conventional Approach

  • Lee, Joon-Woo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kim, Sung-Hyun (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Choi, Ja-Young (Department of Radiology, Seoul National University College of Medicine) ;
  • Yeom, Jin-Sup (Department of Orthopaedic Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Chung, Sang-Ki (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Kim, Choong-Hyo (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Kwack, Kyu-Sung (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kwon, Jong-Won (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Moon, Sung-Gyu (Department of Radiology, Seoul National University College of Medicine) ;
  • Jun, Woo-Sun (Department of Radiology, Seoul National University College of Medicine) ;
  • Kang, Heung-Sik (Department of Radiology, Seoul National University Bundang Hospital)
  • Published : 2006.06.30
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Abstract

Objective: The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. Materials and Methods: The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for the L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3 (very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. Results: Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement. The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (p=0.056; odds ratio: 10.483). Conclusion: We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the diffence between the two treatments had borderline statistical significance.

Keywords

References

  1. Robecchi A, Capra R. Hydrocortisone (compound F); first clinical experiments in the field of rheumatology. Minerva Med 1952;43:1259-1263
  2. Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain 1986;24:277-295 https://doi.org/10.1016/0304-3959(86)90115-6
  3. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27:11-16 https://doi.org/10.1097/00007632-200201010-00005
  4. Gajraj NM. Selective nerve root blocks for low back pain and radiculopathy. Reg Anesth Pain Med 2004;29:243-256 https://doi.org/10.1097/00115550-200405000-00012
  5. Sitzman BT. Epidural injections. In: Fenton DS, Czervionke LF, eds. Image-guided spine intervention. Philadelphia: Saunders, 2003:99-126
  6. Lew HL, Coelho P, Chou LH. Preganglionic approach to transforaminal epidural steroid injections. Am J Phys Med Rehabil 2004;83:378 https://doi.org/10.1097/00002060-200405000-00008
  7. Pfirrmann CW, Oberholzer PA, Zanetti M, Boos N, Trudell DJ, Resnick D, et al. Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectiveness—a study with patients and cadavers. Radiology 2001;221:704-711 https://doi.org/10.1148/radiol.2213001635
  8. Sontag MJ. A theoretical overview of the diagnosis and management of low back pain: acute vs chronic pain and the mind/body continuum. In: Cole AJ, Herring SA, eds. The low back pain handbook: a guide for the practicing clinician, 2nd ed. Philadelphia: Hanley & Belfus, 1993:39-48
  9. Anderson GBJ. Epidemiology of spinal disorders. In: Frymoyer JW, ed. The adult spine: principles and practice. New York: Raven, 1997:93-141
  10. Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine 1996;21:218-224 https://doi.org/10.1097/00007632-199601150-00011
  11. Kanemoto M, Hukuda S, Komiya Y, Katsuura A, Nishioka J. Immunohistochemical study of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 human intervertebral discs. Spine 1996;21:1-8 https://doi.org/10.1097/00007632-199601010-00001
  12. Kawakami M, Weinstein JN, Spratt KF, Chatani K, Traub RJ, Meller ST, et al. Experimental lumbar radiculopathy: Immunohistochemical and quantitative demonstrations of pain induced by lumbar nerve root irritation of the rat. Spine 1994;19:1780-1794 https://doi.org/10.1097/00007632-199408150-00001
  13. Roberts S, Caterson B, Menage J, Evans EH, Jaffray DC, Eisenstein SM. Matrix metalloproteinases and aggrecanase: their role in disorders of the human intervertebral disc. Spine 2000;25:3005-3013 https://doi.org/10.1097/00007632-200012010-00007
  14. Delamarter RB, Bohlman HH, Dodge LD, Biro C. Experimental lumbar spinal stenosis. Analysis of the cortical evoked potentials, microvasculature, and histopathology. J Bone Joint Surg (Am) 1990;72:110-120 https://doi.org/10.2106/00004623-199072010-00018
  15. Olmarker K, Holm S, Rosenqvist A. Experimental nerve root compression. A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy. Spine 1991;16:61-69 https://doi.org/10.1097/00007632-199101000-00012
  16. Schonstrom N, Bolender NF, Spen-gler DM, Hansson TH. Pressure changes within the cauda equina following constriction of the dural sac. An in vitro experimental study. Spine 1984;9:604-607 https://doi.org/10.1097/00007632-198409000-00011
  17. Johnnsson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive c-fibers. Acta Anesthesiol Scand 1990;34:335-338 https://doi.org/10.1111/j.1399-6576.1990.tb03097.x
  18. Kantrowitz F, Robinson DR, McGuire MB, Levine L. Corticosteroids inhibit prostaglandin production by rheumatoid synovia. Nature 1975;258:737-739 https://doi.org/10.1038/258737a0
  19. Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy: An outcome study. Spine 1989;14:431-437 https://doi.org/10.1097/00007632-198904000-00018