Comparison of fluoroscopic Guided Transforaminal Epidural Injections of Steroid and Local Anaesthetic with Conservative Management in Patients with Chronic Lumbar Radiculopathies

Nandita Mehta, Misbah Salaria, A Q Salaria, Nandita Mehta, Misbah Salaria, A Q Salaria

Abstract

Background: Chronic lumbar radiculopathy is a common medical problem and the treatment modalities used over years have been many ranging from conservative or symptomatic management to open decompression surgery. This study was aimed at to compare two modalities of treatment, i.e., conservative and lumbar transforaminal epidural steroid injections (TFESIs).

Materials and methods: A total of 120 patients of American Society of Anesthesiology class - (a healthy patient or a patient with mild systemic disease) were randomized to two groups. Group C (n = 60) were managed conservatively with bed rest, analgesics, and physiotherapy. Group T (n = 60) received lumbar TFESIs with methylprednisolone 40 mg with 2 ml bupivacaine (0.5%). Measurements using visual analog scale (VAS) were taken before treatment and at various time intervals after the start of treatment.

Results: There was no statistically significant difference regarding the demographic characteristics of both groups. The VAS scores were less and statistically significant in Group T after 30 min postinjection, at the 2nd week and after 1 month. Recovery rate of straight leg raise test was found to be 98% in those treated with TFESI. The Group T had significantly better patient satisfaction score and additionally there was drug dose intake reduction before and after the treatment.

Conclusion: Patients treated with fluoroscopic-guided TFESI have better pain relief, quality-of-life, and less analgesic requirement than those managed conservatively.

Keywords: Conservative management; corticosteroids; local anesthetics; radiculopathy; transforaminal epidural steroid injection.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transforaminal epidural steroid injections procedure done UAAP under C-arm guidance in the Department of Anesthesiology and Pain Management, Acharya Shri Chander College of Medical Sciences, Jammu, Jammu and Kashmir, India. (Anteroposterior view).
Figure 2
Figure 2
The pictures are the fluoroscopic pictures of lateral and anteroposterior view while giving transforaminal epidural steroid injection in a 50 years old American Society of Anesthesiology 1 female in our hospital Acharya Shri Chander College of Medical Sciences operating room.
Figure 3
Figure 3
The images show the lateral and the anteroposterior views of the transforaminal epidural steroid/local anesthetic injections in our hospital Acharya Shri Chander College of Medical Sciences operating room.
Figure 4
Figure 4
Transforaminal epidural steroid injections procedure done UAAP under C-arm guidance in the Department of Anesthesiology and Pain Management, Acharya Shri Chander College of Medical Sciences, Jammu, Jammu and Kashmir, India. (Lateral view).
Figure 5
Figure 5
(a and b) Visual analog scale score showing significant improvement at 1 month of ESI (VAS-1) than the conservative treatment (VAS-3).
Figure 6
Figure 6
Patients satisfaction score with 92% patients having no pain 1 month post injection and 78% patients having no pain after conservative management.
Figure 7
Figure 7
The graph depecting the drug dose intake reduction upto 95% after I month in the ESI group and only 75% in the conservative group.

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