Functional outcome of transforaminal epidural steroid injection in lumber disc herniation with radiculopathy
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241697Keywords:
Radiculopathy, Steroid injection, Lumber disc herniationAbstract
Background: Transforaminal epidural steroid injection (TFESI) is a useful therapeutic tool for lumber disc herniation with radiculopathy. TFESI reduce inflammation and edema around herniated disc and nerve root, thus alleviating pain and accelerating the natural history of the herniated disc by shrinkage. This study aims to determine the effectiveness of TFESI in lumber disc herniation with radiculopathy.
Methods: In this prospective observational study, 273 patients were included considering inclusion & exclusion criteria. All subjects received TFESI for lumber disc herniation with radiculopathy. The primary outcome was assessed with a Bengali version of Oswestry disability index (ODI) score and Roland-Morris disability questionnaire (RMDQ) scores at 2 weeks, 1 month, 3 months and 1 year.
Results: From baseline (18.6±3.6), mean RMDQ score was significantly reduced at 2 weeks (14.4±3.7), at 1 month (13.8±3.8), at 3 months (11.6±3.6) and at 1 year (7.8±3.7) respectively. 69.2% patients had severe disability at baseline according to disability rank of ODI score; after procedure during follow up severe disability was found in 21.6% cases at 2 weeks, 9.1% at 1 month, 5.0% at 3 months and 1.2% at 1 year. The reduction of severe disability from baseline in subsequent follow up was significant. From baseline (45.7±10.0), mean ODI score was significantly reduced at 2 weeks (36.4±9.0), at 1 month (28.2±8.9), at 3 months (24.3±8.9) and at 1 year (18.9±10.5) respectively.
Conclusions: Transforaminal epidural steroid injection significantly reduced disability and provide improved functional outcome in patients with lumber disc herniation with radiculopathy.
References
Kuvad VL. A study of transforaminal epidural steroid injections in patients with lumbar disc herniation. Int J Res Med Sci. 2015;3(12):3853-7.
Younes M, Béjia I, Aguir Z, Letaief M, Hassen-Zrour S, Touzi M, et al. Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia. Joint Bone Spine. 2006;73(5):538-42.
Palmer KT, Griffin MJ, Syddall HE, Pannett B, Cooper C, Coggon D. The relative importance of whole body vibration and occupational lifting as risk factors for low-back pain. Occup Environ Med. 2003;60(10):715-21.
Peul WC, Van Houwelingen HC, van den Hout WB. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-56.
Kreiner DS, Hwang S, Easa J, Resnick DK, Baisden J, Bess S, et al. Diagnosis and treatment of lumbar disc herniation with radiculopathy. Lumbar disc herniation with radiculopathy. NASS Clinical Guidelines. 2012.
Tak HJ, Jones R, Cho YW, Kim EH, Ahn SH. Clinical evaluation of transforaminal epidural steroid injection in patients with gadolinium enhancing spinal nerves associated with disc herniation. Pain Physician. 2015;18(2):E177-85.
Kennedy DJ, Levin J, Rosenquist R, Singh V, Smith C, Stojanovic MP, et al. Epidural Steroid Injections are Safe and Effective: Multisociety Letter in Support of the Safety and Effectiveness of Epidural Steroid Injections. Pain Med (Malden, Mass). 2015;16(5):833-8.
Burkhardt BW, Grimm M, Schwerdtfeger K, Oertel JM. The microsurgical treatment of lumbar disc herniation: a report of 158 patients with a mean follow-up of more than 32 years. Spine. 2019;44(20):1426-34.
Kim CH, Chung CK, Choi Y, Kim MJ, Yim D, Yang SH, et al. The long-term reoperation rate following surgery for lumbar herniated intervertebral disc disease: a nationwide sample cohort study with a 10-year follow-up. Spine. 2019;44(19):1382-9.
Wei WB, Dang SJ, Wei L, Liu T, Wang J. Transforaminal epidural steroid injection combined with radio frequency for the treatment of lumbar disc herniation: a 2-year follow-up. BMC Musculoskeletal Disord. 2021;22:1-8.
Ostelo RW, De Vet HC, Knol DL, Van Den Brandt PA. 24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol. 2004;57(3):268-76.
Morita Y, Iseki M, Yonezawa I, Nakahara D, Sakota J, Doi T, et al. Risk Factors for Persistent Pain and Disability in Acute to Subacute Sciatica Caused by Lumbar Disk Herniation After Epidural Injections. Juntendo Med J. 2012;58(3):231-7.
Jang SH, Chang MC. Follow-up of at least five years after lumbar transforaminal epidural steroid injection for radicular pain due to lumbar disc herniation. Ann Palliat Med. 2020;9(1):116-8.
Suleiman ZA, Kolawole IK, Ahmed BA, Babalola OM, Ibraheem GH. Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study. Southern Afr J Anaesth Anal. 2018;24(4):109-13.
Chae JS, Kim WJ, Choi SH. Effects of local anesthetics with or without steroids in high-volume transforaminal epidural blocks for lumbar disc herniation: A randomized, double-blind, controlled trial. J Korean Med Sci. 2022;37(17).
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-52.
Singh JR, Cardozo E, Christolias GC. The clinical efficacy for two-level transforaminal epidural steroid injections. PM R 2017;9(4):377-82.
Güçlü B, Deniz L, Yüce Y, Adilay HU, Aytar H, Türkoğlu M. Transforaminal epidural steroid injection in the treatment of pain in foraminal and paramedian lumbar disc herniations. Turk Neurosurg. 2020;30(3):394-9.
