The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations.
BACKGROUND
Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations.


METHODS
Ninety patients aged 18-60 years with L5-S1 disk herniations and radicular pain were randomly assigned to one of these groups to have epidural steroid injection therapy every 2 wk for a maximum of three injections. Pain relief, disability, and activity levels were assessed.


RESULTS
Pain relief was significantly more effective with TF injections. At 24 wk from the initiation of this study, pain relief was as follows: C: complete pain relief: 1/30, partial pain relief: 16/30, and no relief: 13/30; IL: complete pain relief: 3/30, partial pain relief: 15/30, and no relief: 12/30; and TF: complete pain relief: 9/30, partial pain relief: 16/30, and no relief: 5/30.


CONCLUSIONS
The TF route of epidural steroid placement is more effective than the C or IL routes. We attribute this observation to a higher incidence of steroid placement in the ventral epidural space when the TF method is used.
Ackerman
William E
WE
Pain Medicine Consultants P.A., Little Rock, Arkansas 72223, USA. William.Ackerman@bhsi.com
Ahmad
Mahmood
M
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000188:drug therapy* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D013256:Steroids / Q000008:administration & dosage*
D013256:Steroids