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Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: prospective study of 237 patients with unilateral radicular pain and up to 5 years of follow-up

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Abstract

Objective

To compare the efficacy of the transforaminal approach (TFA) versus the interlaminar approach (ILA) for CT-guided epidural steroid injection (CTESI) in the treatment of persistent lumbosacral radicular pain (LRP > 6 weeks) with long-term follow-up.

Methods

Patients were prospectively assessed for pain by visual analogue scale (VAS) and functional disability (Oswestry Disability Index, (ODI)) before treatment, then 6 weeks (6W), 6 months (6 M), and 5 years (5Y) after CTESI.

Results

Overall, n = 237 patients (TFA, n = 71 and ILA, n = 166) were included, and 96 patients had 5 years of follow-up. Both groups showed a statistically significant improvement in VAS and ODI values at 6W (TFA, n = 60 and ILA, n = 146, P < 0.001 for both), at 6 M (TFA, n = 34 and ILA, n = 96, P < 0.001 for both), and at 5Y (TFA, n = 32 and ILA, n = 64, P < 0.001 for both). No significant differences were observed between the two approaches in VAS or ODI decreases at 6W (P = 0.38 and P = 0.33 respectively), 6 M (P = 0.13 and P = 0.51 respectively), or 5Y (P = 0.15 and P = 0.57 respectively). No major complications were noted.

Conclusion

Outcomes after CTESI by ILA approaches are similar to those by TFA for the treatment of persistent LRP.

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Abbreviations

LRP:

Lumbosacral radicular pain

ESI:

Epidural steroid injections

ILA:

Interlaminar approach

TFA:

Transforaminal approach

MRI:

Magnetic resonance imaging

IMSKR:

Interventional musculoskeletal radiologists

VAS:

Visual analogue scale score

ODI:

Oswestry Disability Index

D0:

Day zero—start of the study

6W:

6 Weeks

6M:

6 Months

5Y:

5 Years

References

  1. US Burden of Disease Collaborators. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.

    Article  PubMed Central  Google Scholar 

  2. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656–64.

    Article  CAS  PubMed  Google Scholar 

  3. Manchikanti L, Singh V, Helm S, et al. An introduction to an evidence-based approach to interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:E1-33.

    Article  PubMed  Google Scholar 

  4. Jacobs WCH, van Tulder M, Arts M, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2011;20:513–22.

    Article  Google Scholar 

  5. Buy X, Gangi A. Percutaneous treatment of intervertebral disc herniation. Semin Interv Radiol. 2010;27:148–59.

    Article  Google Scholar 

  6. Manchikanti L, Benyamin RM, Helm S, Hirsch JA. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: Part 3: Systematic reviews and meta-analyses of randomized trials. Pain Physician. 2009;12:35–72.

    Article  PubMed  Google Scholar 

  7. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ. 2012;344:e497–e497.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J. 2012;21:204–13.

    Article  PubMed  Google Scholar 

  9. Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19:E365-410.

    Article  PubMed  Google Scholar 

  10. Bensler S, Sutter R, Pfirrmann CWA, Peterson CK. Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids? Eur Radiol. 2017;27:1505–11.

    Article  PubMed  Google Scholar 

  11. Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185–212.

    Article  PubMed  Google Scholar 

  12. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12:233–51.

    Article  PubMed  Google Scholar 

  13. Conn A, Buenaventura RM, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the management of chronic low back pain. Pain Physician. 2009;12:109–35.

    Article  PubMed  Google Scholar 

  14. Fenster AJ, Fernandes K, Brook AL, Miller T. The safety of CT-guided epidural steroid injections in an older patient cohort. Pain Physician. 2016;19:E1139–46.

    Article  PubMed  Google Scholar 

  15. Rivera CE. Lumbar epidural steroid injections. Phys Med Rehabil Clin N Am. 2018;29:73–92.

    Article  PubMed  Google Scholar 

  16. Bouhassira D, Attal N, Fermanian J, et al. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108:248–57.

    Article  PubMed  Google Scholar 

  17. Dietrich TJ, Sutter R, Froehlich JM, Pfirrmann CWA. Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update. Skeletal Radiol. 2015;44:149–55.

    Article  PubMed  Google Scholar 

  18. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104:1217–1222, tables of contents.

  19. 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;17:277–90.

    Article  PubMed  Google Scholar 

  20. Chang-Chien GC, Knezevic NN, McCormick Z, Chu SK, Trescot AM, Candido KD. Transforaminal versus interlaminar approaches to epidural steroid injections: a systematic review of comparative studies for lumbosacral radicular pain. Pain Physician. 2014;17:E509-524.

    PubMed  Google Scholar 

  21. Wybier M, Gaudart S, Petrover D, Houdart E, Laredo J-D. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol. 2010;20:181–9.

    Article  PubMed  Google Scholar 

  22. Candido KD, Raghavendra MS, Chinthagada M, Badiee S, Trepashko DW. A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections: the lateral parasagittal interlaminar epidural approach versus the transforaminal epidural approach. Anesth Analg. 2008;106:638–44.

    Article  PubMed  Google Scholar 

  23. Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000;82–A:1589–93.

  24. Kranz PG, Amrhein TJ, Gray L. Incidence of inadvertent intravascular injection during CT fluoroscopy-guided epidural steroid injections. AJNR Am J Neuroradiol. 2015;36(5):1000–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bureau NJ, Moser T, Dagher JH, et al. Transforaminal versus intra-articular facet corticosteroid injections for the treatment of cervical radiculopathy: a randomized, double-blind, controlled study. AJNR Am J Neuroradiol. 2014;35:1467–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Centre d’imagerie ostéo-articulaire, Clinique du sport de Bordeaux, 2 Rue Georges-Negrevergne, 33700, Mérignac, France

    Sylvain Bise, Benjamin Langlet, Lionel Pesquer, Nicolas Poussange, Alain Silvestre & Benjamin Dallaudiere

  2. Département d’imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, Place Amélie-Léon-Rabat, 33000, Bordeaux, France

    Sylvain Bise & Benjamin Dallaudiere

  3. Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Univ. Bordeaux, 146 Rue Léo Saignat, 33076, Bordeaux, France

    Benjamin Dallaudiere

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  1. Sylvain Bise
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Bise, S., Langlet, B., Pesquer, L. et al. Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: prospective study of 237 patients with unilateral radicular pain and up to 5 years of follow-up. Skeletal Radiol 52, 1959–1967 (2023). https://doi.org/10.1007/s00256-023-04290-y

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  • DOI: https://doi.org/10.1007/s00256-023-04290-y

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