Clinical Effectiveness of Single Lumbar Transforaminal Epidural Steroid Injections. Issue 8 (22nd April 2013) - Kaufmann, Timothy J.
Abstract Objectives. To assess the clinical effectiveness of single lumbar transforaminal epidural steroid injections (TFESIs) in subjects with radicular pain with or without radiculopathy. Design. Retrospective observational series. Setting. Single academic radiology pain management practice. Subjects. Two thousand twenty‐four subjects undergoing single lumbar TFESIs at the L4‐5, L5‐S1, or S1 neural foramina. Methods / Outcome Measures. Subjects were assessed with a pain numerical rating scale (NRS, 0–10) and Roland–Morris disability questionnaire (R–M, 23‐point Deyo modification) prior to TFESI and at 2 weeks and 2 months follow‐up. Successful pain relief (responders) was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R–M score. Results. There were statistically significant (P < 0.0001) reductions in mean NRS and R–M scores at 2 weeks and 2 months postinjection. For NRS, 40.9% were responders at 2 weeks and 45.6% at 2 months. For R–M, 31.9% were responders at 2 weeks and 41.3% at 2 months. The proportion of responders for NRS and R–M was higher when there was <3 months of pain (odds ratio 2‐month NRS = 2.42 [95% confidence interval: 1.82, 3.24], odds ratio 2‐month R–M = 2.61 [1.96, 3.48]). For subjects with <3 months of pain, the proportion of responders was 62.4% (56.5, 68.3%) for NRS and 59.3% (53.3, 65.3%) for R–M scores. Conclusions. This retrospective observational study suggests TFESIs are clinically effective in the treatment of lumbar radicular pain. Subjects with a shorter duration of pain are more likely to achieve a successful outcome.