The Efficacy of Transforaminal Epidural Steroid Injection by the Conventional Technique in FarLateral Herniation of Lumbar Disc

Abstract

Background: Owing to the anatomical difference between the far lateral herniation of the lumbar disc (FHLD) and the intraspinal herniation of lumbar disc (iHLD), the outcome of transforaminal epidural steroid injections (TFESI) in patients with FHLD seems to be different from that in patients with iHLD. However, few studies have evaluated the efficacy of TFESI in FHLD. Objective: To evaluate and compare the efficacy of TFESI in FHLD and iHLD patients. Study Design: A retrospective design. Methods: There were 15 and 70 patients in the FHLD and iHLD groups, respectively. Patients received a fluoroscopically guided TFESI. Failure rates of TFESI were recorded, and questionnaires, including a visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) were administered before the initial injection, at 2 weeks, 6 weeks, and 12 weeks after the injections. Results: There was no failure for TFESI in the iHLD group, while 9 patients had to undergo alternative blocks in the FHLD group due to lancinating leg pain when the needle was advanced for TFESI. In the iHLD group, there was a statistically significant improvement in the VAS and ODI score 12 weeks after injection. Considering only successful cases of the FHLD group, significant improvement in the VAS and ODI score was also demonstrated in the FHLD group 12 weeks after injection. Moreover, there was no statistically significant difference of the VAS and ODI between the both groups. Limitations: A relatively small numbers of cases were included in the FHLD group. Conclusion: The current study suggests that an alternative needle placement technique for TFESI appears to be necessary for FHLD patients. Key words: Far lateral herniation of lumbar disc, intraspinal herniation of lumbar disc, transforaminal epidural steroid injection, safe triangle, herniated lumbar disc, visual analog pain scale, Oswestry disability index, radiculopathy

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

“…The injectate diffuses from the spinal nerve root to the lateral recess, resulting in a slow effect and weak efficacy, which leads to less satisfaction. Moreover, a retrospective study[ 7 ] reported that LRB was considerably safer, with a lower chance of nerve pricks[ 19 ] and intravascular dye spread than CTFESI. This study also revealed that a single LRB was significantly better than a single CTFESI in decreasing unilateral radiculopathy pain because the site of drug deposition was more proximal to the discovery interface.…”

Transforaminal Epidural Injection for Far Lateral Lumbar Disc Herniations: An Alternative to Surgery or Just a Delay?

“…Kim et al [ 19 ] evaluated 15 and 70 patients in the FLLDH and intraspinal herniation of lumbar disc groups with fluoroscopically guided TFSI. They found significant improvement in the VAS and ODI score demonstrated in the FLLDH group 12 weeks after injection; moreover, they concluded that there was no statistically significant difference in the VAS and ODI between both the FLLDH and intraspinal disc group [ 19 ].…”