How soon and how often are re-injections performed after first TFESI? A retrospective study on TFESI for low back and radicular pain in a large academic pain center

Abstract

Transforaminal Epidural Steroid Injection (TFESI) has been used for effective management of low back and radicular pain. Initial and re-injections have been found to postpone or reduce the need for surgeries while improving the quality of live and maintain functionality. There has not been a report that examines the burden of pain recurrence in a large academic pain center. Our aim is to investigate when do patients require re-injections and how many times do they need re-injections. A retrospective review of TFESI performed at Mayo Pain Clinic from 2006-2010 was conducted. A total of 2967 patients with low back or radicular pain received 5027 injections, including the first TFESI and subsequent injections, during the subsequent 3-year period for the same pain. Re-injections could be TFESI, ILESI or facet injection. Time and type of each injection were recorded. The result showed that of the 2967 patients who received the first TFESI, 1162 (39%) received a second injection, 455 (15%) received a third, 220 (7%) received a forth, 109 (4%) received a fifth, 60 (2%) received a sixth, and 33 (1%) received a seventh re-injection. The second injection shows a decreasing trend with time, with 245 (21%) during the first month, 210 (18%) during the second, 117 (10%) during the third, 95 (8%) during the forth, 73 (6%) during the fifth, and 62 (5%) during the sixth month. The third injection shows a similar pattern of distribution. Of the 2060 re-injections, 1574 (76%) were TFESI, 137 (7%) were ILESI, and 349 (17%) were facet injections. The findings of this study suggest that around 70% of second injections occur within six month. The number of patients quickly decreases with the increasing number of injections received.