Non-surgical Treatment Option For Patients Research Articles

Poster 141: Are Fluoroscopic transforaminal epidural steroid injections an effective treatment in patients with degenerative lumbar scoliosis and radiculopathy?

Objective: To evaluate the effectiveness of fluoroscopic transforaminal epidural steroid injections as a conservative treatment for patients with degenerative lumbar scoliosis and radiculopathy. Design: Retrospective follow-up study. Setting: Academic outpatient physiatric interventional spine practice. Participants: 62 patients with radiographic evidence of degenerative lumbar scoliosis and complaints of radiculopathy. Intervention: At least 1 fluoroscopic transforaminal epidural steroid injection. Main Outcome Measures: Numeric rating scale (NRS) for worst pain experienced, North American Spine Society (NASS) Satisfaction Scale, amount of pain medication used, and the Adapted Stucki Questionnaire (ASQ) to assess function and pain status. Results: We obtained follow-up on 52 (82.5%) of 61 included patients. We had an average follow-up time of 85.5 weeks (range, 20–152wk), and performed an average of 1.3 injections per patient. We defined a successful outcome as a patient who was both satisfied with his/her results and who experienced at least a 2-point improvement in NRS and ASQ summary pain and summary function scores. Using these criteria for success, 59.6% of our patients had a successful outcome at 1 week postinjection, 55.8% had a successful outcome at 1 month postinjection, 55.8% had a successful outcome at 1 month postinjection, 44.2% had a successful outcome at 3 months postinjection, 37.2% had a successful outcome at 1 year postinjection, and 27.3% had a successful outcome at 2 years postinjection ( P<.01). In addition, 14 (27%) of our patients had complete symptom relief for an average of 1.5 years. Conclusion: Fluoroscopic transforaminal epidural steroid injections are an effective nonsurgical treatment option for patients with degenerative lumbar scoliosis and radiculopathy and should be considered before surgical intervention.

Restenosis following coronary angioplasty: current status.

Restenosis following coronary angioplasty: current status.

Fluoroscopic transforaminal lumbar epidural steroids: An outcome study

Objectives: To determine the therapeutic value and long-term effects of fluoroscopic transforaminal epidural steroid injections in patients with refractory radicular leg pain. Background Data: Although numerous studies have evaluated the efficacy of traditional transsacral (caudal) or translaminar (lumbar) administration of epidural steroids, to our knowledge no studies have assessed specifically the therapeutic value of fluoroscopic transforaminal epidural steroids. Study Design: A prospective case series that investigated the outcome of patients with lumbar herniated nucleus pulposus and radiculopathy who received fluoroscopic transforaminal epidural steroid injections. Methods: Patients who met our inclusion criteria received fluoroscopically guided, contrast-enhanced transforaminal epidural administration of anesthetic and steroid directly at the level and side of their documented pathology. Patients were evaluated by an independent observer and received sequential questionnaires before and after injection, documenting pain level, activity level, and patient satisfaction. Results: Sixty-nine patients met our inclusion criteria and were followed for an average period of 80 weeks (range, 28 to 144 weeks); 75.4% of patients had a successful long-term outcome, reporting at least a >50% reduction between preinjection and postinjection pain scores, as well as an ability to return to or near their previous levels of functioning after only 1.8 injections per patient (range, 1 to 4 injections). Of our patients, 78.3% were satisfied with their final outcomes. Conclusions: Fluoroscopic transforminal epidural steroids are an effective nonsurgical treatment option for patients with lumbar herniated nucleus pulposus and radiculopathy in whom more conservative treatments are not effective and should be considered before surgical intervention.