Follow-up of at least five years after lumbar transforaminal epidural steroid injection for radicular pain due to lumbar disc herniation

Jang, Seung Hwa; Lee, Hee Jin

doi:10.21037/apm.2020.01.05

Cited by 11 publications

(13 citation statements)

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“…There are various causes of spinal pain, such as spinal degeneration, trauma, inflammation, infection, and deformities. In clinical practice, spinal degeneration (herniated disc or spinal stenosis) and trauma are the most common causes of spinal pain [3][4][5]. To alleviate spinal pain, conservative treatments, including rest, physiotherapy (e.g., heat therapy, traction therapy, and manual therapy), injections, orthoses, and medication, are used before the surgical treatment [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of orthoses for treatment in patients with spinal pain

Choo

Lee

2020

Yeungnam Univ J Med

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Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients' lifestyle.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of orthoses for treatment in patients with spinal pain

Choo

Lee

2020

Yeungnam Univ J Med

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“…Jang et al followed up 50 patients with radicular pain due to a HLD for at least 5 years after TFESI. 3 In their study, 25% of the patients showed complete pain resolution; however, 30% of the patients were taking oral pain medications, receiving TFESIs currently, or had undergone a spinal surgery. Compared with the resolution rate in our study (which is 45%), that in the study by Jang et al was lower (at 25%).…”

Section: Discussionmentioning

confidence: 94%

“…Previously, only 2 studies have reported the long-term outcomes of TFESI in patients with lumbosacral radicular pain due to a HLD. 3,28 Kennedy et al 28 followed up 39 patients for a minimum of 5 years after TFESI. In their study, approximately 25% of the patients had current radicular pain.…”

Section: Discussionmentioning

confidence: 99%

“…A herniated lumbar disc (HLD) refers to the displacement of the disc material beyond the intervertebral disc space. 1 It is one of the most common causes of musculoskeletal pain 2,3 ; the prevalence of a symptomatic HLD in the general population is 1%-3%. 1 The HLD causes lumbosacral radicular pain, and its mechanisms are direct mechanical compression of the nerve root and chemical inflammation around the nerve root.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of transforaminal epidural steroid injection in patients with lumbosacral radicular pain according to the location, type, and size of herniated lumbar disc

2021

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Objectives: Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbosacral radicular pain due to herniated lumbar disc (HLD). Objectives:We evaluated the long-term outcomes of TFESI in patients with lumbosacral radicular pain due to an HLD by the location, type, and size of the HLD. Methods:In total, 114 patients who received the initial TFESI at least 4 years ago completed a telephone interview. We investigated the presence of radicular pain, degree of current pain, current pain medications and TFESIs, additional TFESIs, progression to surgery, and trouble in performing daily life activities and occupational job duties. We classified the included patients by the location, type, and size of the HLD, and evaluated whether these factors affected the long-term outcomes of TFESI.Results: At least 4 years after the initial TFESI, radicular pain was completely resolved in 45% of the patients. However, 30% patients were on oral painkillers or repetitive TFESIs or had undergone surgery and 15% had difficulty in performing daily life activities and occupational job duties. A larger number of patients with extruded lumbar disc herniation required additional TFESIs than those with protruded lumbar disc herniation. Apart from this, the outcomes did not significantly differ by the location, type, and size of the HLD. Conclusions:Our findings provide useful information to clinicians managing radicular pain due to HLD.

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“…Herniated lumbar discs (HLDs) are among the most commonly occurring musculoskeletal diseases that cause radiating pain in the lower extremities. 1,2 The mechanisms underlying pain following HLD are chemical inflammation around the nerve roots and their mechanical compression. 3 Chemical inflammation is the main mechanism that underlies radicular pain in most cases of HLD, and it can be successfully managed nonsurgically with interventions such as epidural steroid injections (ESIs) and oral medications.…”

Section: Introductionmentioning

confidence: 99%

<p>The Successful Treatment of Herniated Lumbar Discs That are Refractory to Repeated Epidural Steroid Injection by Using a Navigable Percutaneous Disc Decompression Device: A Case Series</p>

Lee

Boudier‐Revéret

Cho

et al. 2020

JPR

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In most cases, lumbosacral radicular pain caused by herniated lumbar discs (HLDs) can be controlled with epidural steroid injections (ESIs). However, when the HLDs are large, the pain may not respond to ESIs. A navigable, percutaneous, disc decompression device has recently been developed to manage radicular pain that is secondary to HLD, which allows the wand tip to approach the herniated disc by rotating a control wheel. We performed a percutaneous disc decompression using the navigable percutaneous disc decompression device in two patients with a large HLD that did not respond to repeated ESIs. Patients and Methods: Patients A and B are presented with scores of 7 and 8 on the numeric rating scale (NRS), respectively. Both had lumbosacral radicular pain due to right central HLDs at L4-5 and L5-S1, despite repeated ESIs. Percutaneous disc decompression was performed under C-arm fluoroscopy. The wand was inserted through the introducer needle. Using the control wheel, we placed the needle tip on the posterolateral portion of the herniated disc. The radiofrequency current was applied to the herniated portion of the disc. The procedural time was 20-30 minutes. Results: Neither of the patients reported adverse post-procedural effects. At their 1-week follow-up, patient A and B's NRS pain scores had reduced to 2 and 1, respectively. At their 2-year follow-up, patient A had mild pain (NRS 1), and patient B reported no pain. Conclusion: The navigable percutaneous disc decompression device may be effective for pain alleviation in patients with lumbosacral radicular pain that is refractory to repeated ESIs.

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Follow-up of at least five years after lumbar transforaminal epidural steroid injection for radicular pain due to lumbar disc herniation

Cited by 11 publications

References 1 publication

Effectiveness of orthoses for treatment in patients with spinal pain

Effectiveness of orthoses for treatment in patients with spinal pain

Long‐term outcomes of transforaminal epidural steroid injection in patients with lumbosacral radicular pain according to the location, type, and size of herniated lumbar disc

<p>The Successful Treatment of Herniated Lumbar Discs That are Refractory to Repeated Epidural Steroid Injection by Using a Navigable Percutaneous Disc Decompression Device: A Case Series</p>

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