Transforaminal Epidural Steroid Research Articles

Study of outcome of fluoroscopic guided transforaminal lumbar epidural steroid injection in patients with low back pain with radiculopathy

Study of outcome of fluoroscopic guided transforaminal lumbar epidural steroid injection in patients with low back pain with radiculopathy

Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study.

BackgroundLow back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection.MethodsThis was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later.ResultsA total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18.ConclusionFor the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

Management of failed back surgery syndrome with transforaminal epidural steroid and epidural saline adhesiolysis

Failed back surgery syndrome (FBSS) is a condition of persistent pain following spine surgery as a result of epidural adhesions, nerve root entrapment/inflammation. Transforaminal epidural steroid (TFES), interlaminar/caudal epidural (CE) with local anesthetic, saline, steroid and hyaluronidase are established therapeutic options over re-surgery. We report a 55 years old male patient with FBSS since 10 years. Following informed consent, under fluoroscopy guidance TFES given at L4/5, L5/S1 foramina with 1.5 ml 0.25% bupivacaine + triamcinolone 20 mg. Besides, CE injection of 10 ml 0.25% bupivacaine with 50 mcg fentanyl given using 18 gauge Tuohy's needle. Fifteen minutes later 20 ml of 0.9% cold (2°C) normal saline with hyaluronidase (on day 1) was injected forcefully through epidural catheter, repeated on 2 nd and 3 rd day with triamcenolone 20 mg. 90% pain relief persisted till 8 months with improved quality of life. TFES with successive CE saline can be a good therapeutic option for long term relief in FBSS.

Poster 373 Discordant Provocation During Transforaminal Lumbosacral Epidural Steroid Injections Resulted in Greater Pain Reduction

Poster 373 Discordant Provocation During Transforaminal Lumbosacral Epidural Steroid Injections Resulted in Greater Pain Reduction

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Background: Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. Study Design: A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. Objective: To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. Methods: The available literature on lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and by the Newcastle-Ottawa Scale criteria for observational studies. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term &gt; 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 70 studies were identified. Of these, 43 studies were excluded and a total of 27 studies met inclusion criteria for methodological quality assessment with 15 randomized trials (with 2 duplicate publications) and 10 non-randomized studies. For lumbar disc herniation, the evidence is good for transforaminal epidural with local anesthetic and steroids, whereas it was fair for local anesthetics alone and the ability of transforaminal epidural injections to prevent surgery. For spinal stenosis, the available evidence is fair for local anesthetic and steroids. The evidence for axial low back pain and post lumbar surgery syndrome is poor, inadequate, limited, or unavailable. Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: In summary, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids. Key words: Spinal pain, chronic low back pain, lower extremity pain, transforaminal epidural steroids, radiculopathy, sciatica, steroids, local anesthetic

Poster 349: Length of Fluoroscopy Used During Transforaminal Lumbar Epidural Steroid Injections as a Measure of Trainee Competency

Poster 349: Length of Fluoroscopy Used During Transforaminal Lumbar Epidural Steroid Injections as a Measure of Trainee Competency

Intradiscal Flow During a Transforaminal Epidural Steroid Injection

To present a case of inadvertent intradiscal flow during a L4/5 transforaminal epidural steroid injection. Case report. Outpatient private practice. Single case. Lumbar transforaminal epidural steroid injection. Flow of contrast indicating needle entry into extruded disc material with filling of the L4/5 disc. CONCLUSION; This case demonstrates the possibility of needle entry into disc material in the presence of a large lateral disc extrusion with cephalad migration during a transforaminal epidural steroid injection.

Systematic Review of Therapeutic Lumbar Transforaminal Epidural Steroid Injections

Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. The transforaminal route to the lumbar epidural space for steroid injection has gained rapid and widespread acceptance for the treatment of lumbar and leg pain. However, there are few well-designed randomized, controlled studies to determine the effectiveness of epidural injections. The role and value of transforaminal lumbar epidural steroid injections is still questioned. A systematic review of transforaminal epidural injection therapy for low back and lower extremity pain. To evaluate the effect of transforaminal lumbar epidural steroid injections in managing lumbar (low-back) and sciatica (leg) pain. The available literature of lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of the bibliographies of known primary and review articles. The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. The indicated evidence is Level II-1 for short-term relief and Level II-2 for long-term relief in managing chronic low back and lower extremity pain. The limitations of this systematic review include the paucity of literature. The indicated evidence for transforaminal lumbar epidural steroid injections is Level II-1 for short-term relief and Level II-2 for long-term improvement in the management of lumbar nerve root and low back pain.

Poster 229: Can the Distribution of Radicular Pain Predict Who Would Benefit From Transforaminal Cervical Epidural Steroid Injections?

Poster 229: Can the Distribution of Radicular Pain Predict Who Would Benefit From Transforaminal Cervical Epidural Steroid Injections?