Fluoroscopic transforaminal lumbar epidural steroids: an outcome study.
OBJECTIVE
To determine the therapeutic value and long-term effects of fluoroscopic transforaminal epidural steroid injections in patients with refractory radicular leg pain.


BACKGROUND
Although numerous studies have evaluated the efficacy of traditional transsacral (caudal) or translaminar (lumbar) administration of epidural steroids, to our knowledge no studies have assessed specifically the therapeutic value of fluoroscopic transforaminal epidural steroids.


METHODS
A prospective case series that investigated the outcome of patients with lumbar herniated nucleus pulposus and radiculopathy who received fluoroscopic transforaminal epidural steroid injections.


METHODS
Patients who met our inclusion criteria received fluoroscopically guided, contrast-enhanced transforaminal epidural administration of anesthetic and steroid directly at the level and side of their documented pathology. Patients were evaluated by an independent observer and received sequential questionnaires before and after injection, documenting pain level, activity level, and patient satisfaction.


RESULTS
Sixty-nine patients met our inclusion criteria and were followed for an average period of 80 weeks (range, 28 to 144 weeks); 75.4% of patients had a successful long-term outcome, reporting at least a >50% reduction between preinjection and postinjection pain scores, as well as an ability to return to or near their previous levels of functioning after only 1.8 injections per patient (range, 1 to 4 injections). Of our patients, 78.3% were satisfied with their final outcomes.


CONCLUSIONS
Fluoroscopic transforminal epidural steroids are an effective nonsurgical treatment option for patients with lumbar herniated nucleus pulposus and radiculopathy in whom more conservative treatments are not effective and should be considered before surgical intervention.
Lutz
G E
GE
Department of Physical Medicine and Rehabilitation, Hospital for Special Surgery, New York, NY 10021, USA.
Vad
V B
VB
Wisneski
R J
RJ
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D005260:Female; D005471:Fluoroscopy; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology*; D007866:Leg; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids