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

Abstract

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.

Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist

“…Some recent studies suggest that most individuals who are treated with TFESI do not require additional injections, surgery, or oral medications in the long term. [25][26][27] Moreover, TFESI provides an excellent option of pain control to help regain function and facilitate recovery with better engagement and compliance in physical therapy. With the natural history of disease suggesting similar outcomes between surgical and nonsurgical groups in the long term, TFESI may serve as a high-quality bridge option to avoid unnecessary surgical interventions in a large subset of patients with radicular symptoms secondary to LDH.…”

“…As highlighted in this current article and this peer review, TFESI seems to be a promising intermediary option that may offer comparable effectiveness in a significant portion of patients as a surgical intervention while avoiding the potentially serious risks and morbidity associated with surgical management. Some recent studies suggest that most individuals who are treated with TFESI do not require additional injections, surgery, or oral medications in the long term 25–27 . Moreover, TFESI provides an excellent option of pain control to help regain function and facilitate recovery with better engagement and compliance in physical therapy.…”

Transforaminal Epidural Steroid Injection for Patients with Lumbosacral Disc Herniation in the Absence of Spine Magnetic Resonance Imaging – Is Better Really the Enemy of the Best?

“… 5–8 To control the inflammation around the herniated lumbosacral disc, transforaminal epidural steroid injection (TFESI) is commonly used in clinical practice. 9 Its effectiveness in controlling pain due to lumbosacral disc herniation has been demonstrated in several previous clinical trials. 9–11 …”

“… 9 Its effectiveness in controlling pain due to lumbosacral disc herniation has been demonstrated in several previous clinical trials. 9–11 …”

The blind spot and challenges in pain management

“…In clinical practice, corticosteroid injections are mainly used to control musculoskeletal pain [ 5 ]. Although corticosteroid injections can effectively control various musculoskeletal disease-associated pain, several side effects, such as allergic reaction, flushing, hyperglycemia, immunosuppression, menstrual changes, and adrenal suppression may occur [ 6 ].…”