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. 2013 Apr;56(2):89-96.
doi: 10.1503/cjs.014611.

Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

Neil A Manson  1 , Melissa D McKeon, Edward P Abraham
Affiliations

Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

Neil A Manson et al. Can J Surg. 2013 Apr.

Abstract
in English, French

Background: The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery.

Methods: We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers' compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery.

Results: We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers' compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI.

Conclusion: Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.

Contexte: Le temps d’attente médian pour une chirurgie orthopédique au Canada est de 33,7 semaines. Il faut donc trouver des traitements de rechange pour certaines pathologies, telles que les hernies lombaires. Nous avons voulu déterminer si les infiltrations épidurales de corticostéroïdes par voie transforaminale (IECTF) procurent un soulagement ou ne font que retarder le recours à la chirurgie.

Méthodes: Nous avons analysé rétrospectivement les dossiers de patients souffrant d’hernie lombaire qui ont été soumis à des IECTF entre septembre 2006 et juillet 2008. Nous avons tenu compte des caractéristiques démographiques des patients, de l’ampleur et de la latéralité de la pathologie, du statut à l’égard des indemnités pour accidents du travail, des doses injectées, des résultats du traitement et du délai entre la consultation et le traitement. Le paramètre principal était le recours ou non à la chirurgie.

Résultats: Nous avons inclus 91 patients dans notre analyse. Le délai entre la demande de consultation par le médecin de famille et l’administration de l’infiltration a été de 123 (écart-type [ET] 88) jours; aucune différence significative quant au temps d’attente n’a été observée entre les patients soumis à l’IECTF et les patients soumis à la chirurgie. En tout, 51 patients (22 femmes, 29 hommes) âgés en moyenne de 45,8 (ET 10,2) ans ont évité la chirurgie après l’IECTF, tandis que 40 patients (16 femmes, 24 hommes) âgés en moyenne de 43,1 (ET 12,0) ans ont subi une chirurgie dans les 189 (ET 125) jours suivant l’injection. En tout, 15 patients ont reçu plusieurs infiltrations; parmi eux, 9 n’ont pas eu besoin d’une intervention chirurgicale. L’âge, le sexe, l’ampleur et la latéralité de la pathologie n’ont exercé aucune influence sur les résultats du traitement. Le statut à l’égard des indemnités pour accidents du travail a eu une influence significative sur les résultats. Ces patients semblent avoir moins bénéficié des IECTF.

Conclusion: Les infiltrations épidurales de corticostéroïdes par voie transforaminale sont un outil thérapeutique important et préviennent le recours à la chirurgie chez 56 % des patients qui souffrent d’hernie lombaire.

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Figures

Fig. 1
Fig. 1
(A) Sagittal view magnetic resonance imaging scan demonstrating L4/5 disc herniation. (B) Perineural injection of iohexol confirming L5 nerve root location.
Fig. 2
Fig. 2
Median wait times (2009) from referral by a general practitioner (GP) to treatment grouped by specialty. Provided by The Fraser Institute’s National Waiting List Survey, 2009 (www.fraserinstitute.org/).
Fig. 3
Fig. 3
Summary of variables and their association with primary (surgical requirement) and secondary (workers’ compensation status, demographic characteristics) outcomes. LDH = lumbar disc herniation; SD = standard deviation;TFESI = transforaminal steroid injection.
Fig. 4
Fig. 4
The percentage of patients who did and did not require surgical intervention after the first and second injections.
Fig. 5
Fig. 5
Number of patients receiving workers’ compensation who did and did not require surgery.
Fig. 6
Fig. 6
Means and standard deviations for appointment time-lines. Time to effective treatment was statistically different.
See this image and copyright information in PMC

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