Browse > Article

The Prognostic Factors of Selective Transforaminal Epidural Block in Patients with Low Back Pain  

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)
Publication Information
The Korean Journal of Pain / v.20, no.1, 2007 , pp. 54-59 More about this Journal
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
low back pain; outcome; sciatica; selective transforaminal epidural block;
Citations & Related Records
Times Cited By KSCI : 5  (Citation Analysis)
연도 인용수 순위
1 Frymoyer JW, Cats-Baril WL: An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991; 22: 263-71
2 Oksuz E: Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine 2006; 31: E968-72   DOI   ScienceOn
3 Kikuchi S, Hasue M, Nishiyama K, Ito T: Anatomic and clinical studies of radicular symptoms. Spine 1984; 9: 23-30   DOI
4 Sizer PS Jr , Phelps V, Dedrick G, Matthijs O: Differential diagnosis and management of spinal nerve root-related pain. Pain Pract 2002; 2: 98-121   DOI   ScienceOn
5 Cavanaugh JM: Neural mechanisms of lumbar pain. Spine 1995; 20: 1804-9   DOI   ScienceOn
6 Jo DH, Hong JH, Kim MH: The effect of transforaminal epidural block with hyaluronidase and triamcinolone. Korean J Pain 2005; 18: 176-80   DOI   ScienceOn
7 Fredman B, Nun MB, Zohar E, Iraqi G, Shapiro M, Gepstein R, et al: Epidural steroids for treating "failed back surgery syndrome": is fluoroscopy really necessary? Aneth Analg 1999; 88: 367-72   DOI
8 Yoo BH, Kim KT, Kim YJ, Song CW, Hong KH: A prospective study of lumbar spinal root block. Korean J Pain 1997; 10: 77-81
9 Weiner BK, Fraser RD: Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg 1997; 79: 804-7   DOI
10 Manchikanti L: Transforaminal lumbar epidural steroid injections. Pain Physician 2000; 3: 374-98
11 Rydevik B, Brown MD, Lundborg G: Pathoanatomy and pathophysiology of nerve root compression. Spine 1984; 9: 7-15   DOI
12 Takebayashi T, Cavanaugh JM, Kallakuri S, Chen C, Yamashita T: Sympathetic afferent units from lumbar intervertebral discs. J Bone Joint Surg Br 2006; 88: 554-7   DOI
13 Lee KJ, Han SG, Yoon SH, Kim JS, Lee YS: Nerve root block with corticosteroids, hyaluronidase, and local anesthetic in the failed back surgery syndrome (FBSS). Korean J Pain 1999; 12: 191-4
14 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   DOI   ScienceOn
15 Lee P, Helewa A, Goldsmith CH, Smythe HA, Stitt LW: Low back pain: prevalence and risk factors in an industrial setting. J Rheumatol 2001; 28: 346-51
16 Quintero N, Laffont I, Bouhmidi L, Rech C, Schneider AE, Gavardin T, et al: Transforaminal epidural steroid injection and paraplegia: case report and bibliographic review. Ann Readapt Med Phys 2006; 49: 242-7
17 Vad VB, Bhat AL, Lutz GE, Cammisa F: Transforaminal epidural steroid injections in lumbosacral radiculopathy; a prospective randomized study. Spine 2002; 27: 11-6   DOI
18 Jung SS, Lee WH: Comparison of transforaminal epidural steroid injection and lumbar/caudal epidural steroid injection for the treatment of lumbosacral radiculopathy. Korean J Pain 2005; 18: 23-8   DOI   ScienceOn
19 Kallakuri S, Takebayashi T, Ozaktay AC, Chen C, Yang S, Wooley PH, et al: The effects of epidural application of allografted nucleus pulposus in rats on cytokine expression, limb withdrawal and nerve root discharge. Eur Spine J 2005; 14: 956-64   DOI
20 Devulder J, Deene P, De Laat M, Van Bastelaere M, Brusselmans G, Rolly G: Nerve root sleeve injections in patients with failed back surgery syndrome: a comparison of three solutions. Clin J Pain 1999; 15: 132-5   DOI   ScienceOn
21 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   DOI   ScienceOn
22 Huntoon MC, Martin DP: Paralysis after transforaminal epidural injection and previous spinal surgery. Reg Anesth Pain Med 2004; 29: 494-5   DOI
23 Lutz GE, Vad VB, Wisneski RJ: Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998; 79: 1362-6   DOI   ScienceOn
24 Rathmell JP, Benzon HT: Transforaminal injection of steroids: should we continue? Reg Anesth Pain Med 2004; 29: 397-9