title: Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective randomized controlled study.
abstract: OBJECTIVE
  To prospectively evaluate the short- and midterm effectiveness of transforaminal epidural steroid injection (TFESI) for lumbosacral radiculopathy with respect to injection level.
  
  
  METHODS
  Institutional review board approval and written informed consent were obtained. From March 2005 to February 2006, 239 consecutive patients (106 male, 133 female; mean age, 49.8 years; range, 13-82 years) who were scheduled to undergo lumbar TFESI were enrolled. The patients were randomly assigned to either the ganglionic (TFESI at the location of the exiting nerve root) or preganglionic group (TFESI at the supraadjacent intervertebral disk level). Follow-up was conducted within 1 month (short term) and more than 6 months (midterm) after injections. Short- and midterm outcomes were measured by using a visual analog scale and a four-grade scale. Univariate analysis (by using the Fisher exact and chi(2) tests) and multiple logistic regression analysis were performed to evaluate the relationship between possible outcome predictors (ganglionic or preganglionic injection levels, cause of radiculopathy, duration of symptoms, age group, and sex) and the therapeutic effect.
  
  
  RESULTS
  Univariate analysis showed that the preganglionic group had a better treatment effect (99 of 112, 88.4%) than did the ganglionic group (90 of 127, 70.9%) at short-term follow-up (P = .001). Multiple logistic regression analysis showed that the only significant outcome predictor at short-term follow-up was injection level (odds ratio = 2.232, P = .037). No significant difference was identified regarding TFESI approach or cause of radiculopathy at midterm follow-up.
  
  
  CONCLUSIONS
  TFESI for lumbosacral radiculopathy with a preganglionic approach is more effective than TFESI with a ganglionic approach at short-term follow-up.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, Gyeongi-Do, Seoul, Korea.
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Jeong
authors.forename: Joon Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Myung
authors.forename: Joo Hyung
authors.initials: JH
authors.lastname: Kim
authors.forename: Heung Sik
authors.initials: HS
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D001339:Autonomic Fibers, Preganglionic / Q000187:drug effects; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D013256:Steroids