title: An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain.
abstract: BACKGROUND
  Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2). These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI) or computed tomography (CT), even though this treatment scenario has not been adequately studied for this last diagnosis.
  
  
  OBJECTIVE
  To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  PATIENTS WERE SELECTED FROM DATABASES AT TWO SPORTS CLINICS AND DIVIDED INTO TWO GROUPS: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N.
  
  
  RESULTS
  153 patients were eligible for the study (Group D: 93/Group N: 60). Eventually 110 patients responded (Group D: 67/Group N: 43). Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the long term. A larger proportion however, indicated that the injection had certainly improved their symptoms in the short term, but noted that the effects were non-lasting (Group D: 28%/Group N: 30%). Two patients were certain the injections had actually worsened their symptoms. No significant differences in characteristics and outcomes between Group D and Group N were noted.
  
  
  CONCLUSIONS
  Outcomes of this study suggest fluoroscopically guided lumbar cortisone injections may have similar outcomes in patients with non-specific exercise-related lower-limb pain compared to patients with disc prolapse proven on MRI or CT causing back-related lower-limb pain. This might suggest a potential role for these injections in the treatment of non-specific exercise-related lower-limb pain. It should be noted that this is a low level of evidence study (level 3) and further study is warranted.
authors.affiliation: VU University, Amsterdam, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Neve
authors.forename: John
authors.initials: J
authors.lastname: Orchard
authors.forename: Nathan
authors.initials: N
authors.lastname: Gibbs
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Evert
authors.initials: E
authors.lastname: Verhagen
authors.forename: Ken
authors.initials: K
authors.lastname: Sesel
authors.forename: Ian
authors.initials: I
authors.lastname: Burgess
authors.forename: Brett
authors.initials: B
authors.lastname: Hines
keywords: back-related lower-limb pain; fluoroscopically guided cortisone injections