BACKGROUND:Lumbar transforaminal epidural steroid injections (TFESIs) are procedures often utilized in the treatment of radicular pain. TFESIs with a preganglionic approach have been reported to be more effective than TFESIs performed using a classic approach. However, it is unknown whether TFESIs using a retrodiscal approach are as effective as other approaches. OBJECTIVE: To investigate the effect of an epidural steroid injection (ESI) on radicular pain, we conducted a randomized, controlled trial comparing a retrodiscal approach with a classic approach to treat lumbar disc herniation. DESIGN: A case control study. METHODS:Forty patients were randomized to receive lumbar TFESIs with either a retrodiscal approach (n=20) or with a classic approach (n=20). Measurements were taken before as well as 4 and 8 weeks after treatment using a visual analog scale (VAS) score, Patient Satisfaction Index (PSI) and the Roland 5-point pain score. RESULTS: In the retrodiscal group, there was a statistically significant improvement in the VAS score after injection compared to baseline. In the classic group, there was a statistically significant improvement in the VAS score after injection compared to baseline. There was no statistically significant difference in the VAS score, PSI, or the Roland 5-point pain score between those treated with a retrodiscal approache and those treated with a classic approach. LIMITATIONS: Secondary outcomes were not measured and the study did not include a mid- or long-term follow-up period. CONCLUSION: In this study, TFESIs performed using a retrodiscal or classic approach had similar effects on radicular pain. The classic and the retrodiscal transforaminal steroid injection resulted in equivalent pain relief.
RCT Entities:
BACKGROUND: Lumbar transforaminal epidural steroid injections (TFESIs) are procedures often utilized in the treatment of radicular pain. TFESIs with a preganglionic approach have been reported to be more effective than TFESIs performed using a classic approach. However, it is unknown whether TFESIs using a retrodiscal approach are as effective as other approaches. OBJECTIVE: To investigate the effect of an epidural steroid injection (ESI) on radicular pain, we conducted a randomized, controlled trial comparing a retrodiscal approach with a classic approach to treat lumbar disc herniation. DESIGN: A case control study. METHODS: Forty patients were randomized to receive lumbar TFESIs with either a retrodiscal approach (n=20) or with a classic approach (n=20). Measurements were taken before as well as 4 and 8 weeks after treatment using a visual analog scale (VAS) score, Patient Satisfaction Index (PSI) and the Roland 5-point pain score. RESULTS: In the retrodiscal group, there was a statistically significant improvement in the VAS score after injection compared to baseline. In the classic group, there was a statistically significant improvement in the VAS score after injection compared to baseline. There was no statistically significant difference in the VAS score, PSI, or the Roland 5-point pain score between those treated with a retrodiscal approache and those treated with a classic approach. LIMITATIONS: Secondary outcomes were not measured and the study did not include a mid- or long-term follow-up period. CONCLUSION: In this study, TFESIs performed using a retrodiscal or classic approach had similar effects on radicular pain. The classic and the retrodiscal transforaminal steroid injection resulted in equivalent pain relief.
Authors: Laxmaiah Manchikanti; Ramsin M Benyamin; Frank J E Falco; Alan D Kaye; Joshua A Hirsch Journal: Clin Orthop Relat Res Date: 2015-06 Impact factor: 4.176