The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy.
BACKGROUND
Transformational epidural steroid (TFES) is commonly used to treat lumbosacral radicular pain. However, very few studies have systematically evaluated the quality of analgesia following such procedures with respect to time.


OBJECTIVE
To evaluate long-term efficacy of TFES in patients with lumbosacral radiculopathy.


METHODS
A prospective study including 30 patients having lumbosacral radiculopathy secondary to prolapsed disc. Outcome variables were the amount of improvement just after the procedure and thereafter at 24 hrs, 1 month, 6 month and 1 year post-procedure, respectively, using visual analog scale (VAS) and numeric rating scale (NRS). Patients also filled Roland-Morris questionnaire pre-procedure, 6 month and 1 year follow-up. All patients received Ibuprofen for 3 days following the procedure, to alleviate post- procedural pain. An option of rescue surgery was reserved in case of unbearable pain (>7 VAS), appearance of sudden motor deficit or if patient opts for surgery. Same injection was repeated if at any point of time pain had >5 in VAS.


RESULTS
As per NRS, almost all patients had complete pain relief (mean 98%) immediate postprocedure. At 24 hrs, the score was 79%, at 1 month 60%, at 6 months 58.5% and at 1 year 59%. Preprocedure VAS was 9.2 and thereafter 0.6, 1.8, 3.9, 3.8 and 4.2 at similar time points. Roland-Morris score was 18/24, 10/24, 9/24, at pre-procedure, at 6 months and at 1 year, respectively. No complication was noted in any patient except post procedural local pain.


CONCLUSIONS
Quality of pain relief produced by TFES was significant. Long-term quality of pain relief was better in patients with pain duration less than 6 months. Even though, the study was designed to inject the drug once, many of the patients required second injection. A further study with multiple injections at prefixed time interval might probably result in a better overall outcome.
Department of Pain Management, Institute of Neurosciences, Kolkata, West Bengal, India. replychinmoy@yahoo.ca
Chinmoy
C
Roy
Nilay
N
Chatterjee
Satya Narayan
SN
Patro
Amit
A
Chakraborty
G R
GR
Vijay Kumar
Robin
R
Sengupta
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D008137:Longitudinal Studies; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010865:Pilot Projects; D011843:Radiculopathy / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone