Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica

Abstract

The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica. Materials and methods: A total of 219 patients who were diagnosed with unilateral sciatica and underwent transforaminal epidural steroid injections at the level of L4-5, L5-S1, or S1 neural foramina between March 2016 and May 2018 were retrospectively analyzed. The presence of transitional vertebrae and the grade of nerve root compression were evaluated by a radiologist. Data including age, sex, body mass index, duration of symptoms, injection levels, and pain scores were recorded. Pain scores were evaluated using the numerical rating scale. Treatment success was defined as a ≥50% decrease in pain scores at 3 months. Results: The study included 118 female and 101 male patients with a mean age of 43.65 ± 12.18 years. The mean duration of symptoms was 25.64 ± 2.17 weeks. Although the duration of symptoms was longer in patients for whom treatment failed, it did not reach statistical significance. Decreased pain scores at 1 h had a significant effect on treatment success (p = 0.012, odds ratio (OR): 1.015, 95% confidence interval (CI), 1.003-1.026). Conclusions: Our study results suggest that a decreased pain score at 1 h is a predictor for a favorable three-month response to transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica.

Epidural Steroid Injections for Low Back Pain: A Narrative Review

“…In a similar way, Buchner et al found a significant improvement in patients treated with epidural steroid injections for a very short period after the treatment but no improvement was seen after 6 weeks and 6 months, compared to the control group who did not receive the injection [ 47 ]. A response to the treatment after 1 h of having the procedure has been suggested as predictive for favorable medium-term success [ 48 ]. Interestingly, Buttermann et al suggested that ESIs could be more effective in patients who presented magnetic resonance imaging of inflammatory endplate changes [ 49 ].…”

Factors associated with treatment success after combined transforaminal epidural steroid injection and dorsal root ganglion pulsed radiofrequency treatment in patients with chronic lumbar radicular pain

“…Some authors have argued that shorter duration of radicular pain symptoms has a favorable impact on treatment success with TFESI [ 6 ]. In contrast, no correlation between symptom duration and TFESI success was observed in other studies [ 12 ]. However, there is no previous study in the literature investigating the relationship between DRG-PRF treatment for radicular pain and the duration of symptoms.…”

“…Ekedahl et al reported in their study that younger age (53–60 years) was a significant predictor of a favorable response within 1 year after TFESI [ 6 ]. However, the results of another study indicated that patients aged 60–69 years showed higher success after TFESI [ 11 ], while other studies suggested that patient age has no effect on TFESI treatment success [ 12 ]. In a study following patients for 6 months after DRG-PRF treatment, more successful results were obtained in patients aged ≥55 years [ 9 ].…”

“…In a study examining the association between MRI and fluoroscopic image findings and the success of TFESI therapy, the procedure was performed most frequently at L4–5 and second most frequently at L5–S1 [ 15 ]. In another study to identify factors predicting the treatment success of TFESI for LRP, the two most common procedure sites were L5–S1 and the S1 foramen, respectively [ 12 ]. The authors of both studies concluded that procedure level had no effect on treatment success.…”

Interaction between piperine and genes associated with sciatica and its mechanism based on molecular docking technology and network pharmacology

“…Sciatica is a kind of combined pain caused by stimulation and compression of various factors, such as lumbar disk herniation, lumbar degenerative disease and sciatic neuritis, which leads to the pain of stabbing, burning and blunt pain along the line of sciatica nerve walking, as well as the surrounding area, and brings great physiological and psychological pain to patients [1][2][3]. The mechanism of sciatica is very complex, which is often caused by the protrusion of lumbar disk [4].…”