Comparison of treatment outcome of transforaminal and caudal epidural steroid injections for radiating low back pain
Keywords:Transformainal, Caudal, Low back pain, Radiculitis
Background: Low back pain is a common disorder. Nearly everyone is affected by it at some time during one’s life time. Corticosteroid injections showed early and moderate but unsustained improvements versus placebo in certain outcomes for lumbar radiculitis. Hence; the present study was undertaken for assessing and comparing the efficacy of transforaminal and caudal epidural steroid injections outcome for the treatment of lumbar radiculitis.
Methods: The study was conducted prospectively on 60 patients (30 each) from 20-75 years of age. All the patients were divided into two groups; Group A included patients in which Transforaminal route was used while Group B included patients in which caudal route was used. Pain relief was assessed after the epidural steroid injection using visual analogue scale (VAS) and Oswestry disability index (ODI).
Results: Mean VAS and mean ODI score for the patients of Group A was significantly lower in comparison to the patients of group B at post-last injection, 15 days post-last injection, 1-month post-last injection and 3 months post-last injection time interval.
Conclusions: Transforaminal approach exhibited superior efficacy and should be performed with increasing frequency. Transforaminal epidural steroid injection also gave better quality of life.
Saal JA, Saal JS, Herzog RH. The natural history of lumbar intervertebral disc extrusions treated non-operatively. Spine. 1990;15:683-6.
Vik A, Zwart J, Hulleberg G, Nygaard O. Eight year outcome after surgery for lumbar disc herniation: A comparison of reoperated and not reoperated patients. Acta Neurochirurgica. 2001;143:607-11.
Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy. Spine. 2002;27:11-6.
Becker A, Held H, Redaelli M, Strauch K, Chenot JF, Leonhardt C, et al. Low back pain in primary care: Costs of care and prediction of future health care utilization. Spine. 2010;35:1714-20.
Abdi S, Datta S, Trescot A, Schultz D, Adlaka R, Atluri S, et al. Epidural steroids in the management of chronic spinal pain: A systematic review. Pain Physician. 2007;10:185-212.
Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, et al. The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial. J Bone Joint Surg Am. 2012;94:1353-8.
Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16:S49-283.
Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and metaanalysis. Ann Intern Med. 2012;157:865-77.
Benyamin RM, Manchikanti L, Parr AT, Diwan S, Singh V, Falco FJ, et al. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician. 2012;15:E363-404.
Parr AT, Manchikanti L, Hameed H, Conn A, Manchikanti KN, Benyamin RM, et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician. 2012;15:E159-98.
Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15:E199-245.
DePalma MJ, Bhargava A, Slipman CW. A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehab. 2005;86:1477-83.
Datta S, Everett C, Trescot A, Schultz D, Adlaka R, Abdi S, et al. An updated systematic review of the diagnostic utility of selective nerve root blocks. Pain Physician. 2007;10:113-28.
Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2009;25:2940–53.
Nadler SF, Malanga GA, Stitik TP, Keswani R, Foye PM. The crossed femoral nerve stretch test to improve diagnostic sensitivity for the high lumbar radiculopathy: 2 case reports. Arch Phys Med Rehab. 2001;82:522-3.
Hamilton Hall M, Greg McIntosh. Passive straight leg raise test definition, interpretation, limitations and utilization. J Curr Clin Care. 2014;4:23-30.
Cansever T, Kabatas S, Civelek E, Kircelli A, Yilmaz C, Musluman M, et al. Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain. Turk Neurosurg. 2012;22:183-8.
Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10(1):185-212.
Boswell MV, Hansen HC, Trescot AM. Epidural steroids in the management of chronic spinal pain and radiculopathy. Pain Physician. 2003;6:319-34.
Chou R, Atlas SJ, Steven MPH. Nonsurgical interventional therapies for low-back pain. A review of the evidence for an American Pain Society Clinical Practice guideline. Spine. 2009;34:1078-93.
Spaccarelli KC. Lumbar and caudal epidural corticosteroid injections. Mayo Clin Proc. 1996;71:169-78.
Koes BW, Scholten R. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomised clinical trials. Pain. 1995; 63:279-88.
Luijsterburg P, Verhagen A, Ostelo R. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J. 2007;16:881-99.
Nelemans PJ. Injection therapy for subacute and chronic low back pain. Spine. 2001;26:501-15.
Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care. 1995;23(5):564-69.
Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anaesth Analg. 2007;104:1217-22.
Laxmaiah M, Vijay S, Vidyasagar P, Frank JE, Joshua A. Comparison of the efficacy of Caudal, Interlaminar, and Transforaminal epidural Injections in managing lumbar disc herniation: Is one method superior to the other? Korean J Pain. 2015;28:11-21.
Rahatli FK, Harman A, Boyvat F, Zararsiz G. Comparison of transforaminal and interlaminar epidural steroid injection in managing lumbar radiculopathy. Biomedical Res. 2017;28(5):2204-8
Ploumis A, Christodoulou P, Wood KB, Varvarousis D, Sarni JL, Beris A. Caudal vs Transforaminal Epidural Steroid Injections as Short-Term (6 Months) Pain Relief in Lumbar Spinal Stenosis Patients with Sciatica. Pain Med. 2014;15(3):379-85.
Lee JH. Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis. Spine J. 2018;18(12): 2343-53.
Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil. 1998;79(11):1362-6.
Conn A, Buenaventura RM, Datta S. Systematic review of caudal epidural injections in the management of chronic low back-pain. Pain Physic. 2009;12:109-35.
Ergan M, Hansen von Bünau F, Courthéoux P, Viader F, Prouzeau S, Marcelli C. Cerebral vein thrombosis after an intrathecal glucocorticoid injection. Rev Rhum Engl Ed. 1997;64(7-9):513-6.
Wybier M, Gaudart S, Petrover D. Paraplegia complicating selective steroid injections of the lumbar spine. Reportof five cases and review of the literature. Eur J Radiol. 2009;59:1539-47.
Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J. 2012;21:204-13.
Jun L, Hengxing Z, Hiqing F. The effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain. Medicine (Baltimore). 2016;95(18):e3373.