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CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

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Abbreviations

CTG:

CT group

NIG:

Non-imaging group

SEM:

Standard error of the mean

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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.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Moritz C. Deml, Matthias D. Wimmer, Robert Pflugmacher, Yorck Rommelspacher & Koroush Kabir

  2. Clinic for Interventional Spinal and Conservative Orthopedic Treatment, Trierer-Str. 70-72, 53113, Bonn, Germany

    Michael Buhr

  3. Department for Health Economics and Healthcare Research, University of Applied Sciences Cologne, Cologne, Germany

    Rainer Riedel

Authors
  1. Moritz C. Deml
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  2. Michael Buhr
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  3. Matthias D. Wimmer
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  4. Robert Pflugmacher
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  5. Rainer Riedel
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  6. Yorck Rommelspacher
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  7. Koroush Kabir
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Correspondence to Moritz C. Deml.

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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

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  • DOI: https://doi.org/10.1007/s00590-015-1602-9

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