Skip to main content

Advertisement

SpringerLink
Log in

Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to invastigate the effect of the sacralization on the results of transforaminal epidural steroid injection for radicular low back pain.

Materials and methods

The study included 64 patients diagnosed with radicular low back pain due to unilateral and single-level lumbar disk herniation. Patients were divided into 2 groups: patients with sacralization (Group S) and patients without lumbosacral transitional vertebrae (Group A). Injection was applied to the relevant level. Patients were evaluated with Numeric Rating Scale and Modified Oswestry Disability Index before, at week 3 and month 3 after the procedure. Sacralization presence was determined by MRI. Sacralization was categorized by anteroposterior lumbar radiography using Castellvi classification. Treatment success was considered as ≥ 50% reduction in NRS scores.

Results

Numeric Rating Scale and Modified Oswestry Disability Index scores decreased in both groups on both week 3 and month 3 (p < 0.05). Pain scores of Group S (median value 5 (3–6)) were significantly higher than Group A ((median value 3 (0–5)) in the third month follow-up (p = 0.026), but no significant difference was observed at other time points. There was no significant difference in Modified Oswestry Disability Index scores between the groups at all follow-ups (p > 0.05). Treatment success in the third month was 44.8% in Group S and 65.6% in Group A.

Conclusion

Transforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lee JH, Choi KH, Kang S, Kim DH, Kim DH, Kim BR, et al. Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation. Spine J. 2019;19(9):1478–89.

    Article  PubMed  Google Scholar 

  2. Şencan S, Çelenlioğlu AE, Asadov R, Gündüz OH. Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica. Turk J Med Sci. 2020;50(1):126–31.

    PubMed  PubMed Central  Google Scholar 

  3. Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199-245.

    Article  PubMed  Google Scholar 

  4. Celenlıoglu AE, Sencan S, Gunduz OH. Does facet tropism negatively affect the response to transforaminal epidural steroid injections? Prospect Clin Study Skeletal Radiol. 2019;48(7):1051–8.

    Article  Google Scholar 

  5. Ghai B, Bansal D, Kay JP, Vadaje KS, Wig J. Transforaminal versus parasagittal interlaminar epidural steroid injection in low back pain with radicular pain: a randomized, double-blind, active-control trial. Pain Physician. 2014;17(4):277–90.

    Article  PubMed  Google Scholar 

  6. Jancuska JM, Spivak JM, Bendo JA. A review of symptomatic lumbosacral transitional vertebrae: Bertolotti’s syndrome. Int J Spine Surg. 2015;9:42.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Farshad-Amacker NA, Herzog RJ, Hughes AP, Aichmair A, Farshad M. Associations between lumbosacral transitional anatomy types and degeneration at the transitional and adjacent segments. Spine J. 2015;15(6):1210–6.

    Article  PubMed  Google Scholar 

  8. Ravikanth R, Majumdar P. Bertolotti’s syndrome in low-backache population: classification and imaging findings. Ci Ji Yi Xue Za Zhi. 2019;31(2):90–5.

    PubMed  Google Scholar 

  9. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976). 1984;9(5):493–5.

    Article  CAS  PubMed  Google Scholar 

  10. Hanhivaara J, Määttä JH, Karppinen J, Niinimäki J, Nevalainen MT. The association of lumbosacral transitional vertebrae with low back pain and lumbar degenerative findings in MRI: a large cohort study. Spine (Phila Pa 1976). 2022;47(2):153–62.

    Article  PubMed  Google Scholar 

  11. Gopalan B, Yerramshetty JS. Lumbosacral transitional vertebra-related low back pain: resolving the controversy. Asian Spine J. 2018;12(3):407–15.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tang M, Yang XF, Yang SW, Han P, Ma YM, Yu H, et al. Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain. Eur J Radiol. 2014;83(9):1679–82.

    Article  PubMed  Google Scholar 

  13. Nardo L, Alizai H, Virayavanich W, Liu F, Hernandez A, Lynch JA, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology. 2012;265(2):497–503.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bahadir Ulger FE, Illeez OG. The effect of lumbosacral transitional vertebrae (LSTV) on paraspinal muscle volume in patients with low back pain. Acad Radiol. 2020;27(7):944–50.

    Article  PubMed  Google Scholar 

  15. McCormick Z, Cushman D, Caldwell M, Marshall B, Ghannad L, Eng C, et al. Does electrodiagnostic confirmation of radiculopathy predict pain reduction after transforaminal epidural steroid injection? A multicenter study. J Nat Sci. 2015;1(8).

  16. Ekedahl H, Jönsson B, Annertz M, Frobell RB. The 1-year results of lumbar transforaminal epidural steroid injection in patients with chronic unilateral radicular pain: the relation to MRI findings and clinical features. Am J Phys Med Rehabil. 2017;96(9):654–62.

    Article  PubMed  Google Scholar 

  17. Son KM, Lee SM, Lee GW, Ahn MH, Son JH. The impact of lumbosacral transitional vertebrae on therapeutic outcomes of transforaminal epidural injection in patients with lumbar disc herniation. Pain Pract. 2016;16(6):688–95.

    Article  PubMed  Google Scholar 

  18. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001;81(2):776–88.

    Article  CAS  PubMed  Google Scholar 

  19. Tureli D, Ekinci G, Baltacioglu F. Is any landmark reliable in vertebral enumeration? A study of 3.0-Tesla lumbar MRI comparing skeletal, neural, and vascular markers. Clin Imaging. 2014;38(6):792–6.

    Article  PubMed  Google Scholar 

  20. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583–8.

    Article  PubMed  Google Scholar 

  21. Chang MC, Lee DG. Outcome of transforaminal epidural steroid injection according to the severity of lumbar foraminal spinal stenosis. Pain Physician. 2018;21(1):67–72.

    Article  PubMed  Google Scholar 

  22. Bezuidenhout AF, Lotz JW. Lotz, Lumbosacral transitional vertebra and S1 radiculopathy: the value of coronal MR imaging. Neuroradiology. 2014;56(6):453–7.

    Article  PubMed  Google Scholar 

  23. Otani K, Konno S, Kikuchi S. Lumbosacral transitional vertebrae and nerve-root symptoms. J Bone Joint Surg Br. 2001;83(8):1137–40.

    Article  CAS  PubMed  Google Scholar 

  24. Elster AD. Bertolotti’s syndrome revisited. Transitional vertebrae of the lumbar spine. Spine (Phila Pa 1976). 1989;14(12):1373–7.

    Article  CAS  PubMed  Google Scholar 

  25. Hanhivaara J, Määttä JH, Niinimäki J, Nevalainen MT. Lumbosacral transitional vertebrae are associated with lumbar degeneration: retrospective evaluation of 3855 consecutive abdominal CT scans. Eur Radiol. 2020;30(6):3409–16.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihimäki H. Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine (Phila Pa 1976). 2004;29(2):200–5.

    Article  PubMed  Google Scholar 

  27. Apazidis A, Ricart PA, Diefenbach CM, Spivak JM. The prevalence of transitional vertebrae in the lumbar spine. Spine J. 2011;11(9):858–62.

    Article  PubMed  Google Scholar 

  28. Delport EG, Cucuzzella TR, Kim N, Marley J, Pruitt C, Delport AG. Lumbosacral transitional vertebrae: incidence in a consecutive patient series. Pain Physician. 2006;9(1):53–6.

    PubMed  Google Scholar 

  29. Furman MB, Wahlberg B, Cruz EJ. Lumbosacral transitional segments: an interventional spine specialist’s practical approach. Phys Med Rehabil Clin N Am. 2018;29(1):35–48.

    Article  PubMed  Google Scholar 

  30. Sencan S, Edipoglu IS, Bilim S, Gunduz OH. Does coadministration of transforaminal epidural steroid injection with sedation improve patient satisfaction? A prospective randomized clinical study. Pain Physician. 2019;22(4):E287–94.

    PubMed  Google Scholar 

  31. Kennedy DJ, Plastaras C, Casey E, Visco CJ, Rittenberg JD, Conrad B, et al. Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial. Pain Med. 2014;15(4):548–55.

    Article  PubMed  Google Scholar 

  32. Chatterjee N, Roy C, Das S, Al Ajmi W, Al Sharji NS, Al MA. Comparative efficacy of methylprednisolone acetate and dexamethasone disodium phosphate in lumbosacral transforaminal epidural steroid injections. Turk J Anaesthesiol Reanim. 2019;47(5):414–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Assoc. Prof. Canan Şanal Toprak, MD and Assoc. Prof. Esra Giray, MD for their valuable contributions to this study.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca, Fevzi Çakmak, Mahallesi, Pendik, Istanbul, 34906, Turkey

    Savas Sencan, Sahin Azizov & Osman Hakan Gunduz

  2. Department of Pain Medicine, University of Health Sciences Gulhane Training and Research Hospital, General Dr.Tevfik Sağlam Cd. No:1, Etlik, Ankara, 06010, Turkey

    Alp Eren Celenlioglu

  3. Department of Pain Medicine, Adıyaman University Training and Research Hospital, Ziyaretpayamlı/Adıyaman, Merkez/Adıyaman, Turkey

    Serhad Bilim

Authors
  1. Savas Sencan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sahin Azizov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alp Eren Celenlioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Serhad Bilim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osman Hakan Gunduz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alp Eren Celenlioglu.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Written informed consent was obtained from all patients

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sencan, S., Azizov, S., Celenlioglu, A.E. et al. Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial. Skeletal Radiol 52, 1949–1957 (2023). https://doi.org/10.1007/s00256-022-04089-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-022-04089-3

Keywords

Search

Navigation