Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach.
OBJECTIVE
The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc.


METHODS
The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for the L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3 (very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed.


RESULTS
Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement. The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (p = 0.056; odds ratio: 10.483).


CONCLUSIONS
We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the difference between the two treatments had borderline statistical significance.
Lee
Joon Woo
JW
Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-do, Korea.
Kim
Sung Hyun
SH
Choi
Ja-Young
JY
Yeom
Jin-Sup
JS
Kim
Ki-Jeong
KJ
Chung
Sang-Ki
SK
Kim
Hyun-Jib
HJ
Kim
Choonghyo
C
Kwack
Kyu Sung
KS
Kwon
Jong Won
JW
Moon
Sung Gyu
SG
Jun
Woo Sun
WS
Kang
Heung Sik
HS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications; D016015:Logistic Models; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011843:Radiculopathy / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000150:complications; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
D000779:Anesthetics, Local; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D002045:Bupivacaine