Research – Lumbar Transforaminal Epidural Steroid Injections

** click the blue article titles below for the abstracts
note: recent additions will be added to the top of the list

12 - Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis

  • Clin J Pain. 2009 Mar-Apr;25(3):206-10
  • Looked at patients with axial low back pain only (no radiculopathy)
  • In patients with spinal stenosis (SS), the bilateral transforaminal ESI produced better results than the interlaminar approach.
  • Authors believe this was because there is more scaring with SS, and this limits the amount of injectate to the ventral epidural space.

11 - Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy

  • AJNR Am J Neuroradiol. 2006 May;27(5):978-82.
  • “…a simple, safe, and effective nonsurgical procedure…that should be performed quite early in the course of the illness”
  • Patients with excellent results = ~3 months duration of symptoms before injection
  • Patients with poor results = ~8 months duration of symptoms

10 - Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations

  • Pain Physician. 2006 Oct;9(4):361-6.
  • Transforaminal epidural steroid injections: ¹better short-term pain improvement, and ²fewer long-term surgical interventions than interlaminar epidural steroid injection

9 - Effectiveness of transforaminal epidural steroid injections in low back pain: a one year experience

  • Pain Physician. 2002 Jul;5(3):266-70
  • 59% of patients with discogenic abnormalities on MRI experienced >50% pain relief at one year after initial injection

8 – Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy

  • Pain Physician. 2004 Jul;7(3):311-7
  • Post injection success: One week = 59.6%; One month = 55.8%; One year = 37.2%; Two years = 27.3%
  • “…an effective nonsurgical treatment option for patients with degenerative lumbar SCOLIOTIC stenosis and radiculopathy and should be considered before surgical intervention.”

7 – Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach

  • Korean J Radiol. 2006 Apr-Jun;7(2):139-44   *images of the preganglionic approach can be found in the link above
  • “…preganglionic TFESI has the better therapeutic effect…the difference between the two treatments had borderline statistical significance.”

6 - Transforaminal epidural steroid injection for discectomy candidates: an outcome study with a minimum of two-year follow-up

  • Chang Gung Med J. 2006 Jan-Feb;29(1):93-9
  • “…relatively simple, effective and low-risk alternative to surgical decompression for the treatment of lumbar disc herniation”
  • Improves the patient’s daily activity and reduces the need for surgical decompression

5 - A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy

  • Arch Phys Med Rehabil. 2005 Jul;86(7):1477-83
  • The evidence for TFESIs reveals level III (moderate) evidence.  More prospective, randomized, placebo-controlled studies using sham procedures are needed.

4 – Fluoroscopy guided L5-S1 transforaminal injection as a treatement for s1 radiculopathy

  • J Radiol. 2004 Nov;85(11):1937-41.
  • Significant improvement: Day 8 = 60%; Day 30 = 60-67%; Day 90 = 67%
  • Good efficacy in the treatment of S1 radiculopathy

3 - Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study

  • Arch Phys Med Rehabil. 2004 Mar;85(3):479-84
  • Used transforaminal and caudal fluoroscopically-guided injections
  • Pain relief: More than 2 months = 32%; Less than 2 months = 39%; No relief = 29%
  • Improved function in 53%
  • Only 20% had surgery

2 - Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study

  • Spine (Phila Pa 1976). 2002 Jan 1;27(1):11-6
  • Lumbar transforaminal ESI vs normal saline trigger point injection (mock ESI)
  • After an average follow-up of 1.4 years, the TF-ESI group had success rate of 84%, compared to the trigger point group with 48%

1 - Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain

  • Swiss Med Wkly. 2001 Feb 10;131(5-6):75-80.
  • 30 patients with clinical and MRI findings justifying surgery
  • 87% had rapid pain relief; 60% had permanent resolution of pain, so surgery was avoided at the average of 16-month follow-up.
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This post was written by:

Christopher Faubel, MD - who has written 183 posts on The Pain Source.

Pain Medicine Fellowship (2011/2012) - Louisiana State University

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Christopher Faubel, MD

Pain Medicine Fellowship (2011/2012) - Louisiana State University

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