Outcome of Transforaminal Epidural Steroid Injection According to the Severity of Lumbar Foraminal Spinal Stenosis

Abstract

Background: Lumbar foraminal spinal stenosis (LFSS) is a common cause of radicular pain in the lower extremities. Transforaminal epidural steroid injection (TFESI) is being used widely for controlling radicular pain induced by LFSS. The efficacy of TFESI has been demonstrated in previous studies. However, no study has evaluated the outcome of TFESI according to the severity of LFSS. Objective: In this study, we evaluated the outcome of TFESI in patients with chronic lumbar radicular pain due to LFSS according to the severity of LFSS by using magnetic resonance imaging (MRI). Study Design: A prospective observational study. Setting: A university hospital. Methods: Sixty patients with chronic lumbar radicular pain due to LFSS were included in this prospective study and received TFESI at our university hospital. Three patients were lost to followup. On the basis of sagittal lumbar MRI findings, we assigned patients with mild to moderate LFSS to group A (n = 31) and those with severe LFSS to group B (n = 26). Pain intensity was evaluated using a numeric rating scale (NRS) before treatment and at 1, 2, and 3 months after treatment. Results: Compared to pretreatment NRS scores, a significant decrease in NRS scores was observed in patients in both groups at 1, 2, and 3 months after treatment (P = 0.000). However, reductions in the NRS scores over time were significantly larger in group A (P = 0.023). Three months after treatment, 27 patients (87.1%) in group A and 11 patients (42.3%) in group B reported successful pain relief (pain relief of ≥ 50%). Limitations: This study had a small number of patients. Conclusions: After TFESI, chronic lumbar radicular pain was significantly reduced regardless of the severity of LFSS, and the effects of TFESI were sustained for at least 3 months after treatment. However, the outcome of TFESI was superior in the group with a mild to moderate degree of LFSS, compared to the group with a severe degree of LFSS. We believe that our study provides useful information for establishing a treatment plan for radicular pain due to LFSS. Key words: Lumbar foraminal spinal stenosis, transforaminal epidural steroid injection, disease severity, magnetic resonance imaging, numeric rating scale, corticosteroids

At Least 5‐Year Follow‐up After Transforaminal Epidural Steroid Injection Due to Lumbar Radicular Pain Caused by Spinal Stenosis

“…The short‐term positive effectiveness of TFESI for controlling radicular pain following LSS has been well demonstrated in several previous studies 7,11–14 . However, the long‐term outcome of TFESI on LSS has been rarely studied.…”

“…Of these, stenosis of the lateral recess or the foraminal canal induces radicular pain, which originates from ischemia and compression of the nerve roots 6 . The lumbar radicular pain following LSS decreases the quality of life and hinders the activities of daily living 7 …”

“…For controlling radicular pain, oral medication and various types of physical therapies can be utilized. However, if the pain is not resolved despite these therapies, transforaminal epidural steroid injection (TFESI) can be administered 7 . Steroids inhibit the synthesis of various pro‐inflammatory mediators.…”

“…Additionally, it can block the transmission of nociceptive signals through the nerve fibers 10 . The short‐term pain‐reducing effects of lumbar TFESI is well demonstrated 7,11–14 . However, little is known about the long‐term effect of lumbar TFESI for managing lumbar radicular pain due to LSS.…”

Conservative Treatments Frequently Used for Chronic Pain Patients in Clinical Practice: A Literature Review

“…Intervertebral disc herniation or stenosis of the spine can cause inflammation or compression of the vertebral nerve, which often leads to chronic pain [ 11 , 12 ]. In addition, compression of peripheral nerves, as in carpal tunnel syndrome, tardy ulnar neuropathy, meralgia paresthetica, and tarsal tunnel syndrome, can be accompanied by neurogenic pain, often leading to chronic pain.…”