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Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach.

Authors
Lee, JW; Kim, SH; Choi, JY; Yeom, JS; Kim, KJ; Chung, SK; Kim, HJ; Kim, C; Kwack, KS; Kwon, JW; Moon, SG; Jun, WS; Kang, HS
Citation
Korean journal of radiology, 7(2):139-144, 2006
Journal Title
Korean journal of radiology
ISSN
1229-69292005-8330
Abstract
OBJECTIVE: The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc.



MATERIALS AND METHODS: The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for the L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3 (very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed.



RESULTS: Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement. The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (p = 0.056; odds ratio: 10.483).



CONCLUSION: We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the difference between the two treatments had borderline statistical significance.
MeSH terms
AdolescentAdultAgedAnesthetics, Local/administration & dosageBupivacaine/administration & dosageFemaleFluoroscopyGlucocorticoids/administration & dosage*HumansInjections, Epidural/methods*Intervertebral Disk Displacement/complicationsLogistic ModelsLumbosacral RegionMaleMiddle AgedPain MeasurementPatient SatisfactionRadiculopathy/drug therapy*Radiculopathy/etiologyRetrospective StudiesSpinal Stenosis/complicationsTriamcinolone Acetonide/administration & dosage*
DOI
10.3348/kjr.2006.7.2.139
PMID
16799275
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
AJOU Authors
곽, 규성
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