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

Savaş Şencan, Alp Eren Çelenlioğlu, Ruslan Asadov, Osman Hakan Gündüz, Savaş Şencan, Alp Eren Çelenlioğlu, Ruslan Asadov, Osman Hakan Gündüz

Abstract

Background/aim: 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.

Keywords: Epidural injection; back pain with radiation; herniated disc; low back pain; magnetic resonance imaging; sciatica.

Conflict of interest statement

None declared.

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

    1. Konstantinou K Dunn KM Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33:2464.
    1. Mulleman D Mammou S Griffoul I Watier H Goupille P Pathophysiology of disk-related sciatica. Spine: Revue du Rhumatisme. 2006;73:151.
    1. Kennedy DJ Plastaras C Casey E Visco CJ Rittenberg JD Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial. Pain Medicine (Malden. 2014;15:548.
    1. Bhatia A Flamer D Shah PS Transforaminal epidural steroid injections for treating lumbosacral radicular pain from herniated intervertebral discs: a systematic review and meta-analysis. Anesthesia and Analgesia. 2016;122:857.
    1. Abram SE Epidural steroid injections for the treatment of lumbosacral radiculopathy. Journal of Back and Musculoskeletal Rehabilitation. 1997;8:135.
    1. Abdi S Datta S Trescot AM Schultz DM Adlaka R Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185.
    1. Ghai B Bansal D Kay JP Vadaje KS Wig J Transforaminal versus parasagittal interlaminar epidural steroid injection in low back pain with radicular pain: a randomized, double-blind, active-control trial. Pain Physician. 2014;17:277.
    1. Inman SL Faut-Callahan M Swanson BA Fillingim RB Sex differences in responses to epidural steroid injection for low back pain. The Journal of Pain. 2004;5:450.
    1. Choi SJ Song JS Kim C Shin MJ Ryu DS The use of magnetic resonance imaging to predict the clinical outcome of non-surgical treatment for lumbar intervertebral disc herniation. Korean Journal of Radiology. 2007;8:156.
    1. Ghahreman A Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Medicine (Malden. 2011;12:871.
    1. Cyteval C Fescquet N Thomas E Decoux E Blotman F Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. American Journal of Neuroradiology. 2006;27:978.
    1. Paidin M Hansen P McFadden M Kendall R Contrast dispersal patterns as a predictor of clinical outcome with transforaminal epidural steroid injection for lumbar radiculopathy. PM & R. 2011;3:1022.
    1. Lee JW Choi SW Park SH Lee GY Kang HS MR-based outcome predictors of lumbar transforaminal epidural steroid injection for lumbar radiculopathy caused by herniated intervertebral disc. European Radiology. 2013;23:205.
    1. Cushman Z Casey D Garvan E Kennedy C DJ Factors associated with pain reduction after transforaminal epidural steroid injection for lumbosacral radicular pain. Archives of Physical Medicine and Rehabilitation. 2014;95:2350.
    1. El-Yahchouchi C Wald J Brault J Geske J Hagen C Lumbar transforaminal epidural steroid injections: does immediate post-procedure pain response predict longer term effectiveness? Pain Medicine. 2014;15:921.
    1. Taskaynatan MA Tezel K Yavuz F Tan AK The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment. Journal of Back and Musculoskeletal Rehabilitation. 2015;28:447.
    1. Lechmann M Rosskopf A Ehrmann C Sutter R Pfirrmann CW Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections. Skeletal Radiology. 2016;45:1677.
    1. Jung YS Suh JH Kim HY Min K Oh Y The prognostic value of enhanced-MRI and fluoroscopic factors for predicting the effects of transforaminal steroid injections on lumbosacral radiating pain. Annals of Rehabilitation Medicine. 2016;40:1071.
    1. Ekedahl H Jonsson B Annertz M Frobell RB Three week results of transforaminal epidural steroid injection in patients with chronic unilateral low back related leg pain: the relation to MRI findings and clinical features. Journal of Back and Musculoskeletal Rehabilitation. 2016;29:693.
    1. Tecer D Adiguzel E Tan AK Taskaynatan MA Role of magnetic resonance imaging in ascertaining the success of transforaminal epidural steroid injection for lumbar. Pain Medicine (Malden. 2017;18:645.
    1. Ekedahl H Jonsson B Annertz M Frobell RB The 1-year results of lumbar transforaminal epidural steroid injection in patients with chronic unilateral radicular pain: the relation to MRI findings and clinical features. American Journal of Physical Medicine & Rehabilitation. 2017;96:654.
    1. Sencan S Ozcan-Eksi EE Cil H Tay B Berven S The effect of transforaminal epidural steroid injections in patients with spondylolisthesis. Journal of Back and Musculoskeletal Rehabilitation. 2017;30:841.
    1. Manchikanti L Benyamin RM Falco FJ Kaye AD Hirsch JA Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clinical Orthopaedics and Related Research. 2015;473:1940.
    1. Tureli D Ekinci G Is any landmark reliable in vertebral enumeration? A study of 3.0-Tesla lumbar MRI comparing skeletal, neural, and vascular markers. Clinical Imaging. 2014;38:792.
    1. Pfirrmann CW Dora C Schmid MR Zanetti M Hodler J MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230:583.
    1. Vidyasagar K. Assessment of the growth of epidural injections in the Medicare population from 2000 to 2011. Pain Physician. 2013;16:E349.

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