1.Transforaminal Epidural Steroid Injection for Lumbosacral Radiculopathy: Preganglionic versus Conventional Approach.
Joon Woo LEE ; Sung Hyun KIM ; Ja Young CHOI ; Jin Sup YEOM ; Ki Jeong KIM ; Sang Ki CHUNG ; Hyun Jib KIM ; Choonghyo KIM ; Kyu Sung KWACK ; Jong Won KWON ; Sung Gyu MOON ; Woo Sun JUN ; Heung Sik KANG
Korean Journal of Radiology 2006;7(2):139-144
OBJECTIVE: The present study was undertaken to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) with using a preganglionic approach for treating lumbar radiculopathy when the nerve root compression was located at the level of the supra-adjacent intervertebral disc. MATERIALS AND METHODS: The medical records of the patients who received conventional TFESI at our department from June 2003 to May 2004 were retrospectively reviewed. TFESI was performed in a total of 13 cases at the level of the exiting nerve root, in which the nerve root compression was at the level of the supra-adjacent intervertebral disc (the conventional TFESI group). Since June 2004, we have performed TFESI with using a preganglionic approach at the level of the supra-adjacent intervertebral disc (for example, at the neural foramen of L4-5 for the L5 nerve root) if the nerve root compression was at the level of the supra-adjacent intervertebral disc. Using the inclusion criteria described above, 20 of these patients were also consecutively enrolled in our study (the preganglionic TFESI group). The treatment outcome was assessed using a 5-point patient satisfaction scale and by using a VAS (visual assessment scale). A successful outcome required a patient satisfaction scale score of 3 (very good) or 4 (excellent), and a reduction on the VAS score of > 50% two weeks after performing TFESI. Logistic regression analysis was also performed. RESULTS: Of the 13 patients in the conventional TFESI group, nine showed satisfactory improvement two weeks after TFESI (69.2%). However, in the preganglionic TFESI group, 18 of the 20 patients (90%) showed satisfactory improvement. The difference between the two approaches in terms of TFESI effectiveness was of borderline significance (p = 0.056; odds ratio: 10.483). CONCLUSION: We conclude that preganglionic TFESI has the better therapeutic effect on radiculopathy caused by nerve root compression at the level of the supra-adjacent disc than does conventional TFESI, and the diffence between the two treatments had borderline statistical significance.
Triamcinolone Acetonide/*administration & dosage
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Spinal Stenosis/complications
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Retrospective Studies
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Radiculopathy/*drug therapy/etiology
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Patient Satisfaction
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Pain Measurement
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Middle Aged
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Male
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Lumbosacral Region
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Logistic Models
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Intervertebral Disk Displacement/complications
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Injections, Epidural/*methods
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Humans
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Glucocorticoids/*administration & dosage
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Fluoroscopy
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Female
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Bupivacaine/administration & dosage
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Anesthetics, Local/administration & dosage
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Aged
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Adult
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Adolescent