The Clinical Efficacy for Two-Level Transforaminal Epidural Steroid Injections.
BACKGROUND
Epidural steroid injections have been used in combination with other modalities for the treatment of lumbar radicular pain. The literature has shown that 1-level lumbar fluoroscopically guided transforaminal epidural steroid injections (TFESIs) are effective in decreasing pain and morbidity; however, the efficacy of 2-level TFESIs has not been investigated, although they are performed by many practitioners in the treatment of lumbar radicular pain.


OBJECTIVE
To assess the clinical effectiveness of 2-level TFESIs in patients with unilateral, single-level lumbar radicular pain. In addition, a subgroup analysis was performed based on disk herniation location.


METHODS
Retrospective cohort.


METHODS
Outpatient physiatry pain practice.


METHODS
A total of 721 patients were included in this study having undergone a two-level transforaminal epidural steroid injection.


METHODS
The study group included patients who underwent a 2-level lumbar TFESI. Patients presented for lumbar radicular pain as the result of disk herniation with or without radiculopathy and were scheduled to receive a lumbar TFESI at L3 or below. Of this group, only those that underwent a 2-level TFESIs were included in the study, and data analysis was carried out on this group.


METHODS
Subjects were assessed with a pain numerical rating scale (NRS 0-10) and Oswestry Disability Index (ODI) before TFESI and at 2-week and 2-month follow-up. Responders were defined as greater that 50% reduction in NRS or greater than 40% reduction in ODI.


RESULTS
A total of 57.7% of patients were responders in terms of NRS (P < .05, confidence interval 53.6%-61.9%) and 51.7% responded in ODI at 2-month follow-up (P < .05 [confidence interval 47.5%-55.9%]). In addition, patients with complete pain relief (defined as 0/10 on NRS) were noted at both 2-week (n = 239, 33%) and 2-month (n = 130, 18%) follow-up. In subgroup analysis, the paracentral/subarticular disk group had an increased number of responders, 66.0% in NRS and 64.0% in ODI at 2-month follow-up (P < .05).


CONCLUSIONS
Two-level TFESIs are effective in the management of radicular pain, but more research is needed to evaluate the utility of this treatment compared with single-level TFESI. Our study showed a greater improvement in pain and function as a result of 2-level TFESIs in the setting of paracentral/subarticular disk herniations.


METHODS
IV.
Department of Rehabilitation Medicine, New York Presbyterian- Weill Cornell Medical Center, 525 E 68th Street, Baker 16, New York, NY 10065(∗). Electronic address: Dr@RickySinghMD.com.
Jaspal R
JR
Singh
Department of Rehabilitation Medicine, New York Presbyterian - University Hospital of Columbia and Cornell, New York Presbyterian, New York, NY(†).
Eliana
E
Cardozo
Department of Rehabilitation and Regenerative Medicine, New York Presbyterian-Columbia Medical Center, New York, NY(‡).
George C
GC
Christolias
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D008161:Lumbosacral Region / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D011843:Radiculopathy / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones