Niel Davis1, Patrick Hourigan2, Andrew Clarke3. 1. a Specialist Registrar in Trauma and Orthopaedics , Royal Devon and Exeter Hospital , UK. 2. b Extended Scope Physiotherapist , Royal Devon and Exeter Hospital , UK. 3. c Consultant Spinal Orthopaedic Surgeon , Royal Devon and Exeter Hospital , UK.
Abstract
BACKGROUND CONTEXT: Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. PURPOSE: To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. STUDY DESIGN/ SETTING: An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. PATIENT SAMPLE: A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. OUTCOME MEASURES: The primary outcome measure was the avoidance of decompressive surgery. METHODS: Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. RESULTS: Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. CONCLUSIONS: Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.
BACKGROUND CONTEXT: Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. PURPOSE: To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. STUDY DESIGN/ SETTING: An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. PATIENT SAMPLE: A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. OUTCOME MEASURES: The primary outcome measure was the avoidance of decompressive surgery. METHODS:Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. RESULTS: Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. CONCLUSIONS: Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.