Comparative study of functional efficacy of trans foraminal Vs interlaminar epidural steroid injection for lumbar disc disease

Saravanan, B (2016) Comparative study of functional efficacy of trans foraminal Vs interlaminar epidural steroid injection for lumbar disc disease. Masters thesis, Madras Medical College, Chennai.


Download (46MB) | Preview


INTRODUCTION: In recent years, understanding of disc degeneration has undergone a significant transformation. Impairments of the back and spine are ranked as the most frequent cause of limitation of activity in individuals younger than 45 years old by the National Center for Health Statistics Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. AIM OF STUDY: To compare efficacy of pain relief function of therapeutic transforaminal vs interlaminar epidural steroid injections for symptomatic lumbar disc disease patients. To assess improvement in functional outcome in lumbar disc disease patents after treatment. To evaluate duration of relief and long term outcome after epidural steroid injections. To assess the quality of improvement in pain relief. To assess patient satisfaction after steroid injection. MATERIALS AND METHODS: • Duration of study – 18 months since 1/3/2014 to 30-9-2015 • Study design - prospective & retrospective study • Sample size – 50 in each group Inclusion Criteria: 1. Patients with duration of back pain and radiculopathy for more than 6 months with radiological evidence (MRI & X- RAY) of lumbar disc disease. 2. MRI scan showing an herniated nucleosus pulposus (HNP) of intervertebral disc with less than 50% intervertebral canal narrowing with manifestations of backache and radiculopathy. 3. HNPs at various interspaces (L3–L4, L4–L5, L5–S1) and with differing axial presentations (e.g., far lateral, paracentral, and central protrusion) were examined. 4. Age group between 18 to 65 years. Exclusion Criteria: 1. Patients with more than 2 level lumbar disc disease. 2. Patients with progressive neurological deficits. 3. Patients who underwent prior lumbar surgery. 4. Patients with a large herniation with severe central or foraminal stenosis on MRI. 5. Coagulation disorder. 6. Patients with a history of anaphylaxis to local anesthetics or corticosteroid. Outcome of treatment was measured by 1. PATIENT SATISFACTION SCALE. It had choice options as 0 (poor) 1 (fair) 2 (good) 3 (very good) and 4 (excellent). 2. ROLAND MORRIS LOW BACK PAIN DISABILITY QUESTIONNAIRE (RMDQ) showing improvement by reduction of 5 scores; 3. Measurement of FINGER-TO FLOOR DISTANCE. 4. VISUAL NUMERIC PAIN SCALE similar to the visual analog scale with a range of options from 0 (no pain) to 10 (worst pain). RESULTS: First month 64% patients had significant reduction of disability in TFESI group whereas it was 32% for ILESI group. By the end of study period significant disability improvement persisted in 40% in TFESI group, it was 18% for ILESI group In TFESI group statistically significant results noted in RMDQ at 1month, 3rd month, 6th month and in Finger Floor Distance analysis at 1st month, 3rd month, 6th month and in Patient Satisfaction Score analysis at 1st month, 3rd month, 6th month, also in12th month and in Visual Numeric Scale Assessment in 1st month. CONCLUSION: 1. Epidural steroid injections are safe . 2. Patients with radicular pain from disc herniation or lumbar canal stenosis obtain significant relief from a preganglionic LTFESI irrespective of age, gender, level of injection, symptom duration and pain intensity. 3. Transforaminal epidural steroid therapy has better outcome with respect to Roland Morris disability assessment, Visual Numeric Scale, Finger Floor Distance assessment, Patient Satisfaction Score. 4. Transforaminal steroid injection is superior to ILESI . 5. Interlaminar steroid administration is also useful if it is done under fluoroscopic guidance. 6. Transforaminal group disablity improves significantly.. In majority of the patients response lasts more than year. 7. Lumbar transforaminal epidural steroid injections (LTFESI) are cost-effective. Transforaminal epidural steroid treatment better medication for pain relief, patient satisfaction, disability improvement and functional improvement.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Lumbar Disc Disease, Intervertebral Disc Prolapse, Epidural Steroid, Transforaminal epidural steroid, interlaminar epidural steroid.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 13:39
Last Modified: 16 Sep 2017 13:39

Actions (login required)

View Item View Item