Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis

Abstract

of Transforaminal Epidural Steroid Injection in Lumbar Spinal StenosisO ne of the degenerative pathologies of the lumbar spine is lumbar spinal stenosis (LSS) and it is a common cause of radicular pain. [1][2][3] The pathology appears as foramen, lateral recess and central stenosis on lumbar magnetic resonance image (MRI). The morphologic classification of LSS on lumbar MRI has been described by measuring the dural sac cross-sectional surface area in the literature. [4] The severe and extreme stenosis is treated with surgery generally and minor or moderate stenosis is treated conservatively. The complaints of patients are low back pain or bilaterally leg pain in a few patients. According to our clinical experience, especially in the foramen and lateral recess ste-Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically. Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year. Results: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks. It was 2.8±0.2, 3.1±0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6±0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3 after two weeks. It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months. Conclusion:The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.

The role of transforaminal nerve block in the treatment of lumbar disc herniation and spinal canal stenosis

“…The transforaminal epidural injection was reported to be a safe and effective treatment module as a nonsurgical treatment for LCS and LDH. [16] Many mechanisms have been described, such as that the corticosteroids stop the arachidonic acid production resulting in the inhibition of the pain-generating pathway or directly relieving central pain sensitization. Another possibility is that the nerve roots stretch due to injections in the epidural space, causing the lysis of neural adhesions, with more pain relief.…”

Changes in pain scores and walking distance after transforaminal epidural steroid injection in patients with lumbar foraminal spinal stenosis

“…[6] In contrast, Yuce et al and Donohue et al reported a decrease in pain scores in patients who underwent TFESI for the treatment of radicular low back pain; however, making a direct comparison with the findings of the present study is difficult. [1,4]…”

“…[6] In contrast, Yuce et al and Donohue et al reported a decrease in pain scores in patients who underwent TFESI for the treatment of radicular low back pain; however, making a direct comparison with the findings of the present study is difficult. [1,4] TFESI is an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. [4] Olguner et al reported that 64% of the patients with foraminal stenosis experienced pain relief (pain score reduction of ≥50%).…”

“…[3,4] Thus, TFESI has been increasingly used in patients with lumbar foraminal spinal stenosis. [1,2]…”

“…[3,4] Thus, TFESI has been increasingly used in patients with lumbar foraminal spinal stenosis. [1,2] Previous studies have reported positive results regarding the role of TFESI in pain reduction in patients with lumbar foraminal spinal stenosis. [5][6][7] TFESI provides a significant decrease in pain intensity and an improved walking distance in the third week compared with the baseline in patients with lumbar central spinal stenosis.…”