Effectiveness of epidural steroid injection in the management of lumbar prolapsed intervertebral disc using interlaminar and transforaminal route

Abstract

Introduction: In the conservative management of lumbar intervertebral prolapsed disc, the epidural steroid injection is one of the important modality. There is a controversy with respect to decrease the pain and how much improvement in the function of daily activities.Aim: The purpose of this study was to assess the efficacy of steroids via transforaminal and interlaminar epidural route and to compare their results. Materials and Methods: A prospective study of 64 patients with prolapsed lumbar intervertebral disc diagnosed in MRI were included and treated with epidural steroid methyl prednisolone via interlaminar and transforaminal routes 32 each by using computer generated randomization by using our hospital software ie., R L Jalappa Hospital, Tamaka, Kolar, Karnataka, India between April 2018 to May 2019. Pre injection and post injection Japanese Orthopaedic Association (JOA) Score was calculated and effectiveness of the medication was calculated for each route. The data was compared by ANOVA and LSD method to prove the significance. Average follow-up was six months.Results: At six months after epidural steroid injection, both interlamiar and transforaminal routes were found to be effective in improving the JOA Score (Interlaminar in 87.5% and transforaminal in 96.875%). Transforaminal route was significantly more effective than interlaminar route (p=0.03) at 6 months after injection. Conclusion: For patients having lower back pain with or without radiculitis diagnosed in MRI with prolapsed lumbar intervertebral disc can be managed conservatively by using epidural steroid injection and is satisfactory in our study. Both interlaminar and transforaminal routes are effective. By transforaminal route we obtained best result.