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).
Conclusion
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.
Similar content being viewed by others
Abbreviations
- CTG:
-
CT group
- NIG:
-
Non-imaging group
- SEM:
-
Standard error of the mean
References
Statistisches Bundesamt, Gesundheit, Krankheitskosten (2008): Fachserie 12, Serie 7.2: 36
Balague F, Af M, Pellise F, Cedraschi C (2007) Clinical update: low back pain. Lancet 369:726–728
Karppinen J, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26(9):1059–1067
Ridley MG, Kingsley GH, Gibson T, Grahame R (1988) Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 27:295–299
DePalma MJ, Bhargava A, Slipman CW (2005) A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehabil 86:1477–1483
Young IA, Hyman GS, Packia-Raj LN, Cole AJ (2007) The use of lumbar epidural/transforaminal steroids for managing spinal disease. J Am Acad Orthop Surg 15:228–238
Roberts ST, Willick SE, Rho ME, Rittenberg JD (2009) Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review. PM+ R 1(7):657–668
Vad VB, Bhat AL, Lutz GE, Cammisa F (2002) Transforaminal epidural steroid injections in lumbarsacral radiculopathy: a prospective randomised study. Spine 27:11–16
Lutz GE, Vad VB, Wisneski RJ (1998) Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 79(11):1362–1366
Tajima T, Furukawa K, Kuramochi E (1980) Selective lumbosacral radiculography and Block. Spine 5:68–77
Artner J, Lattig F, Reichel H, Cakir B (2012) Effective dose of CT-guided epidural and periradicular injections of the lumbar spine: a retrospective study. Open Orthop J 6:357–361
Dilke TFW, Burry HC, Grahame R (1973) Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 2(5867):635–637
German Institute for Medical Documentation and Infromation (2006) Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme 10. Revision Version 2006 WHO-Ausgabe http://www.dimdi.de/dynamic/de/klassi/downloadcenter/icd-10who/version2006/regelwerk/x2vbp2006.zip [2nd of March 2007]
Theodoridis T (2007) Injection therapy of the spine without imaging. Orthopaede 36(1):73–85
Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levésque J, Bergeron V, Montminy P, Blanchette C (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336(23):1634–1640
Lee KS, Lin CL, Hwang SL, Howng SL, Wang CK (2005) Transforaminal periradicular infiltration guided by CT for unilateral sciatica: an outcome study. J Clin Imag 29:211–214
Seibel RMM, Groenemeyer DHW, Grumme TH (1990) New methods of treatment of spinal column diseases using interventional radiological techniques. In: Seibel RMM, Groenemeyer DHW (eds) Interventional computed tomography, 1st edn. Blackwell, Boston, pp 100–115
Mink JH, Deutsch AL, Goldstein TB (1998) Spinal imaging and intervention. Phys Med Rehabil Clin North Am 9:343–380
Cyteval C, Fescquet N, Thomas E, Decoux E, Blotman F, Taourel P (2006) Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. Am J Neuroradiol 27(5):978–982
Lutze M, Stendel R, Vesper J, Brock M (1997) Periradicular therapy in lumbar radicular syndrome: methodology and results. Acta Neurochir (Wien) 139:719–724
Olmarker K, Rydevik B, Nordborg C (1993) Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine 18:1425–1432
Igarashi T, Kikuchi S, Shubayev V, Myers RR (2000) Volvo award winner in basic science studies: exogenous tumor necrosis factor-alpha mimics nucleus pulposus induced neuropathology. Molecular, histologic, and behavioral comparisons in rats. Spine 25:2975–2980
Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T (1996) Inflammatory cytokines in the herniated disc of the lumbar spine. Spine 21:218–224
Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K (2000) 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 Jt Surg Am 82-A(11):1589–1593
Conflict of interest
None of the authors have a competing interest to disclose in relation with this work. There was no founding of this research work. There was no presentation of this data before.
Ethical statement
This study is in accordance with the Helsinki Declaration. No human experimentation was done.
Consent statement
Routine clinical data were collected and analysed retrospectively, anonymized and in aggregate, thus no consent was obtained.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Deml, M.C., Buhr, M., Wimmer, M.D. et al. CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica. Eur J Orthop Surg Traumatol 25 (Suppl 1), 177–182 (2015). https://doi.org/10.1007/s00590-015-1602-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-015-1602-9