Holger Joswig1, Armin Neff2, Christina Ruppert3, Gerhard Hildebrandt4, Martin Nikolaus Stienen5. 1. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Clinical Neurological Sciences, Division of Neurosurgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada. Electronic address: holger.joswig@gmail.com. 2. Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 3. ZHAW School of Applied Psychology, Zurich, Switzerland. 4. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 5. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: A previous report demonstrated predictive power of short-term leg pain relief after lumbar transforaminal epidural steroid injections for 1-month treatment response. The question whether the long-term response could be similarly predicted remained unanswered. METHODS: A prospective cohort of 57 patients who underwent a transforaminal epidural steroid injection for sciatica secondary to a lumbar disc herniation was followed for 24 months. Leg and back pain on the visual analog scale, health-related quality of life using the 12-Item Short Form Survey, and functional outcome using the Oswestry Disability Index were assessed. Responders were defined as not receiving any additional invasive treatment after a single injection. Patients who underwent a second injection or surgery were defined as treatment failures (nonresponders). RESULTS: At 24 months, 31 (54.4%) patients were responders, and 26 (45.6%) were nonresponders. Nonresponders left follow-up at 1 month (n = 9), 3 months (n = 9), 6 months (n = 6) and 12 months (n = 2). No patients were injected again or operated on between the 12- and 24-month follow-up. Responders at 24 months had significantly lower visual analog scale leg pain (P < 0.05) than nonresponders starting from the second week after TFESI and better 12-Item Short Form Survey scores and less disability on the Oswestry Disability Index. CONCLUSIONS: Most patients with a symptomatic lumbar disc herniation who opt for a second injection or surgery do so within the first 6 months. Reliable prediction of the long-term treatment response based on short-term pain relief is not possible.
BACKGROUND: A previous report demonstrated predictive power of short-term leg pain relief after lumbar transforaminal epidural steroid injections for 1-month treatment response. The question whether the long-term response could be similarly predicted remained unanswered. METHODS: A prospective cohort of 57 patients who underwent a transforaminal epidural steroid injection for sciatica secondary to a lumbar disc herniation was followed for 24 months. Leg and back pain on the visual analog scale, health-related quality of life using the 12-Item Short Form Survey, and functional outcome using the Oswestry Disability Index were assessed. Responders were defined as not receiving any additional invasive treatment after a single injection. Patients who underwent a second injection or surgery were defined as treatment failures (nonresponders). RESULTS: At 24 months, 31 (54.4%) patients were responders, and 26 (45.6%) were nonresponders. Nonresponders left follow-up at 1 month (n = 9), 3 months (n = 9), 6 months (n = 6) and 12 months (n = 2). No patients were injected again or operated on between the 12- and 24-month follow-up. Responders at 24 months had significantly lower visual analog scale leg pain (P < 0.05) than nonresponders starting from the second week after TFESI and better 12-Item Short Form Survey scores and less disability on the Oswestry Disability Index. CONCLUSIONS: Most patients with a symptomatic lumbar disc herniation who opt for a second injection or surgery do so within the first 6 months. Reliable prediction of the long-term treatment response based on short-term pain relief is not possible.
Authors: Eduard Verheijen; Alexander G Munts; Oscar van Haagen; Dirk de Vries; Olaf Dekkers; Wilbert van den Hout; Carmen Vleggeert-Lankamp Journal: BMC Neurol Date: 2019-09-03 Impact factor: 2.474
Authors: Anna Maria Zeitlberger; Marketa Sosnova; Michal Ziga; Valentin Steinsiepe; Oliver P Gautschi; Martin N Stienen; Nicolai Maldaner Journal: Neurospine Date: 2020-03-31
Authors: Scott M Johnson; Troy Hutchins; Miriam Peckham; Yoshimi Anzai; Elizabeth Ryals; H Christian Davidson; Lubdha Shah Journal: BMJ Open Qual Date: 2019-12-11