title: Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations.
abstract: BACKGROUND
  Epidural steroid injections are commonly used for the treatment of radicular symptoms associated with symptomatic lumbar intervertebral disc herniations. Transforaminal epidural injections are believed to produce better clinical outcomes than interlaminar epidural injections.
  
  
  OBJECTIVE
  To determine a difference in short-term pain improvement and longterm surgical rates between interlaminar and transforaminal injection techniques.
  
  
  METHODS
  Case Control Study.
  
  
  METHODS
  For each technique, 20 patients were retrospectively identified who received their first fluoroscopically guided epidural steroid injection for radicular symptoms caused by a lumbar intravertebral disc herniation over an 18 months interval. All patients had corresponding MRI findings and failed previous non-invasive therapies. The Verbal Numerical Rating Scale (VNRS, 0-10 scale) before the treatment, within one hour after the treatment and upon follow-up (average 17.1 days) were analyzed, along with the need for repeat injections and surgical interventions over a 1-year follow-up interval. The patient groups were matched for symptom duration, MRI findings and pre-injection VNRS scores.
  
  
  RESULTS
  In the transforaminal group, there was a statistically significant improvement in the VNRS scores from before the injection (VNRS mean 5.9) to immediately after the injection (VNRS mean 2.9, p<0.01), and upon follow-up (VNRS mean 3.2, p<0.01, mean 18.7 days). Nine patients (45%) required 1 or 2 repeated injections, 2 patients (10%) underwent surgery. In the interlaminar group, there was a statistically significant improvement in the VNRS scores from before the injection (VNRS mean 7.3) to immediately after the injection (VNRS mean 3.1, p<0.01), and upon follow-up (VNRS mean 5.9, p<0.01, mean 15.6 days). Eight patients (40%) required 1 or 2 repeated injection, 5 patients (25%) underwent surgery. Fourteen patients (70%) had an improvement of 2 points or more on the VNRS scale in the transforaminal group, compared to 9 (45%) in the interlaminar group.
  
  
  CONCLUSIONS
  In the current study, transforaminal epidural steroid injections for the treatment of symptomatic lumbar disc herniation resulted in better short-term pain improvement and fewer long-term surgical interventions than interlaminar epidural steroid injection.
authors.affiliation: The Emory Spine Center, Emory University School of Medicine, Atlanta, Georgia 30329, USA. michael.schaufele@emoryhealthcare.org
authors.forename: Michael K
authors.initials: MK
authors.lastname: Schaufele
authors.forename: Laura
authors.initials: L
authors.lastname: Hatch
authors.forename: William
authors.initials: W
authors.lastname: Jones
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D006801:Humans; D007268:Injections, Epidural / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008012:Lidocaine / Q000008:administration & dosage; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000473:pathology / Q000503:physiopathology*; D008775:Methylprednisolone / Q000008:administration & dosage; D011843:Radiculopathy / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000187:drug effects / Q000503:physiopathology; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D013256:Steroids; D008012:Lidocaine; D008775:Methylprednisolone