The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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The Prognostic Factors of Selective Transforaminal Epidural Block in Patients with Low Back Pain

요하지통 환자에서 선택적 경추간공 경막외강 블록의 예후 인자

  • Choi, Byung In (Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Han, Jeong Mi (Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Kweon, Tae Dong (Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Lee, Youn-Woo (Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine)
  • 최병인 (연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소) ;
  • 한정미 (연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소) ;
  • 권태동 (연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소) ;
  • 이윤우 (연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소)
  • Received : 2007.03.30
  • Accepted : 2007.05.23
  • Published : 2007.06.30
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Abstract

Background: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. Methods: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. Results: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. Conclusions: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

Keywords

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