Outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar spondylolisthesis patients

Abstract

Study design: A prospective cohort.

Purpose: To report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients.

Overview of literature: TFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS.

Methods: The DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes.

Results: Thirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up.

Conclusions: TFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale.

Keywords: Degenerative lumbar; Epidural injection; Outcome; Spondylolisthesis; Steroid.

Fig. 1

Anteroposterior (A) and lateral (B) fluoroscopic projection of preganglionic transforaminal epidural steroid injection in lumbar spondylolisthesis patient showing contrast outlining L4 existing nerve root and spreading into epidural space.

Fig. 2

Line graph showing the VAS of one level of stenosis DLS patients and two levels of stenosis DLS patients over time. There was a significant difference (p=0.0124) between these two groups. VAS, visual analog scale; DLS, lumbar spondylolisthesis.

Fig. 3

Line graph showing the Roland 5-point pain scale of one level of stenosis DLS patients and two levels of stenosis DLS patients over time. There was a significant difference (p=0.004) between these two groups. DLS, lumbar spondylolisthesis.

Fig. 4

Line graph showing standing tolerance of one level of stenosis DLS patients and two levels of stenosis DLS patients over time. There was a significant difference (p<0.001) between these two groups. DLS, lumbar spondylolisthesis.

Fig. 5

Line graph showing walking tolerance of one level of stenosis DLS patients and two levels of stenosis DLS patients over time. There was a significant difference (p<0.001) between these two groups. DLS, lumbar spondylolisthesis.

Fig. 6

Line graph showing the patient satisfaction scale of one level of stenosis DLS patients and two levels of stenosis DLS patients over time. There was no significant difference (p=0.058) between these two groups. DLS, lumbar spondylolisthesis.