Role of triamcinolone acetate in treatment of symptomatic intervertebral disc herniations via interlaminar vs transforaminal approach

Abstract

Introduction: Lowback pain is one of the most common chronic pain disorders, with 2-3% incidence of lumbar disk herniations among population. Epidural corticosteroid injections have been used since 1952 for treatment of lumbar radiculopathy with or without discogenic back pain in patient with failed medical and conservative management. Local Steroids such as triamcinolone acetate acts by limiting inflammatory response. Several approaches are available; interlaminar, transforaminal and caudal. This study was conducted to compare the efficacy of triamcinolone acetate injection by interlaminar vs transforaminal approach. AIM: To compare the efficacy of triamcinolone acetate in terms of pain relief between interlaminar approach and transforaminal approach. Methodology: In this study 60 patients with low back pain are randomly allocated to one of the two groups of 30 patients each. In both group 40mg of triamcinolone acetate solution is used. In IL approach, drug is injected blindly in the epidural space, while in TF approach drug is injected under fluoroscopic guidance using dye. Outcome consists of measuring pain relief at 2nd and 4th week after injection using Numerical Scale and Verbal Rating Scale. Data was collected after 15mins, at 2nd week and at 4th week after the injection. RESULTS: The pain relief in NRS and VAS at 2 nd week was more in patient who received triamcinolone acetate via transforaminal approach. Conclusion: Transforaminal is superior to interlaminar, as it gives target specific administration of triamcinolone acetate and is more effective than ILESI comparing the NRS and VAS score in terms of pain relief.