Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study.
METHODS
A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted.


OBJECTIVE
To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radiculopathy secondary to a herniated nucleus pulposus.


BACKGROUND
Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radiculopathy secondary to a herniated nucleus pulposus.


METHODS
Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months).


RESULTS
After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005).


CONCLUSIONS
Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral radiculopathy secondary to a herniated nucleus pulposus.
Vad
Vijay B
VB
The Hospital for Special Surgery, New York, New York 10021, USA. vadv@hss.edu
Bhat
Atul L
AL
Lutz
Gregory E
GE
Cammisa
Frank
F
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage; D003287:Contrast Media; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007472:Iohexol; D008012:Lidocaine / Q000008:administration & dosage; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012585:Sciatica / Q000188:drug therapy / Q000209:etiology; D012965:Sodium Chloride / Q000008:administration & dosage; D013256:Steroids / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000779:Anesthetics, Local; D003287:Contrast Media; D013256:Steroids; D007472:Iohexol; D012965:Sodium Chloride; D001623:Betamethasone; D008012:Lidocaine