title: The efficacy of transforaminal epidural steroid injection by the conventional technique in far-lateral herniation of lumbar disc.
abstract: BACKGROUND
  Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD.
  
  
  OBJECTIVE
  To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients.
  
  
  METHODS
  A retrospective design.
  
  
  METHODS
  There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections.
  
  
  RESULTS
  There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups.
  
  
  CONCLUSIONS
  A relatively small numbers of cases were included in the FHLD group.
  
  
  CONCLUSIONS
  The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients.
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Joon-Hee
authors.initials: JH
authors.lastname: Park
authors.forename: Keun-Mann
authors.initials: KM
authors.lastname: Shin
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Kang
authors.forename: Il-Seok
authors.initials: IS
authors.lastname: Kim
authors.forename: Sung-Jun
authors.initials: SJ
authors.lastname: Hong
authors.forename: Chang-Keun
authors.initials: CK
authors.lastname: Song
authors.forename: Jung-Chan
authors.initials: JC
authors.lastname: Park
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D055959:Intervertebral Disc Degeneration / Q000188:drug therapy*; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D000890:Anti-Infective Agents; D013256:Steroids