title: CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica.
abstract: BACKGROUND
  Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5.
  
  
  METHODS
  A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine.
  
  
  RESULTS
  In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008).
  
  
  CONCLUSIONS
  This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany, moritz.deml@ukb.uni-bonn.de.
authors.forename: Moritz C
authors.initials: MC
authors.lastname: Deml
authors.forename: Michael
authors.initials: M
authors.lastname: Buhr
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Wimmer
authors.forename: Robert
authors.initials: R
authors.lastname: Pflugmacher
authors.forename: Rainer
authors.initials: R
authors.lastname: Riedel
authors.forename: Yorck
authors.initials: Y
authors.lastname: Rommelspacher
authors.forename: Koroush
authors.initials: K
authors.lastname: Kabir
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D059925:Anatomic Landmarks; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D060186:Infusions, Spinal / Q000379:methods; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000000981:diagnostic imaging; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011843:Radiculopathy / Q000188:drug therapy* / Q000209:etiology; D015642:Radiology, Interventional; D012189:Retrospective Studies; D062707:Return to Work; D012585:Sciatica / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D002045:Bupivacaine