Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov;24(8):1024-1034.
doi: 10.1111/papr.13397. Epub 2024 Jul 1.

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis

Ying-Wei Yang  1   2 , Chia-Shiang Lin  1   2   3   4   5   6 , Hsuan-Chih Lao  1   2   7 , Ying-Chun Lin  1   2   3   8
Affiliations

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis

Ying-Wei Yang et al. Pain Pract. 2024 Nov.

Abstract

Background: Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet.

Aim: To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI).

Methods: Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed.

Results: A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008).

Conclusion: The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

Keywords: contrast distribution; epidural steroid injection; far lateral lateral recess approach; fluoroscopy; herniated intervertebral disc; lumbar; radiculopathy; transforaminal.

PubMed Disclaimer

References

REFERENCES

    1. Tsujimoto R, Abe Y, Arima K, Nishimura T, Tomita M, Yonekura A, et al. Prevalence of lumbar spondylosis and its association with low back pain among community‐dwelling Japanese women. BMC Musculoskelet Disord. 2016;17:493.
    1. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33:2464–2472.
    1. Anderson G. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The adult spine: principles and practice. New York: Raven Press; 1991.
    1. Berry JA, Elia C, Saini HS, Miulli DE. A review of lumbar radiculopathy, diagnosis, and treatment. Cureus. 2019;11:e5934.
    1. Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence‐based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14:180–191.

LinkOut - more resources