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

Abstract

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 difference between the two treatments had borderline statistical significance.

Fig. 1

Schematic description for transforaminal epidural steroid injection with the preganglionic approach versus the conventional approach.

Fig. 2

A 20-year-old girl with left leg pain. On the T2-weighted MR images (A), an extruded disc (arrow) was evident at L5-S1. This disc was located in the left central zone and it had migrated inferiorly to compress the left S1 nerve root (arrowhead). We performed transforaminal epidural injection with using the preganglionic approach at the L5-S1 level (B, C). In the oblique view (B), the needle tip was inserted just lateral to the pars interarticularis (arrow). The leg pain had been relieved at the 2-week follow-up.