The Clinical Efficacy for Two‐Level Transforaminal Epidural Steroid Injections. Issue 4 (7th September 2016)

• Record Type: Journal Article
• Authors: Singh, Jaspal R.; Cardozo, Eliana; Christolias, George C.
• Is Part Of: PM&R. Volume 9:Issue 4(2017)
• Page Start: 377
• Page End: 382
• Publication Date: 2016-09-07
• Subjects: Medical rehabilitation -- Periodicals; Physical therapy -- Periodicals; Physical Therapy Modalities -- Periodicals; 615.5
• DOI: 10.1016/j.pmrj.2016.08.030
• Languages: English
• ISSNs: 1934-1482

Abstract

Abstract: Background: Epidural steroid injections have been used in combination with other modalities for the treatment of lumbar radicular pain. The literature has shown that 1‐level lumbar fluoroscopically guided transforaminal epidural steroid injections (TFESIs) are effective in decreasing pain and morbidity; however, the efficacy of 2‐level TFESIs has not been investigated, although they are performed by many practitioners in the treatment of lumbar radicular pain. Objectives: To assess the clinical effectiveness of 2‐level TFESIs in patients with unilateral, single‐level lumbar radicular pain. In addition, a subgroup analysis was performed based on disk herniation location. Study Design: Retrospective cohort. Setting: Outpatient physiatry pain practice. Patients: A total of 721 patients were included in this study having undergone a two‐level transforaminal epidural steroid injection. Methods: The study group included patients who underwent a 2‐level lumbar TFESI. Patients presented for lumbar radicular pain as the result of disk herniation with or without radiculopathy and were scheduled to receive a lumbar TFESI at L3 or below. Of this group, only those that underwent a 2‐level TFESIs were included in the study, and data analysis was carried out on this group. Main Outcome Measures: Subjects were assessed with a pain numerical rating scale (NRS 0‐10) and Oswestry Disability Index (ODI) before TFESI and at 2‐week and 2‐month follow‐up. Responders were defined as greater that 50% reduction in NRS or greater than 40% reduction in ODI. Results: A total of 57.7% of patients were responders in terms of NRS ( P < .05, confidence interval 53.6%‐61.9%) and 51.7% responded in ODI at 2‐month follow‐up ( P < .05 [confidence interval 47.5%‐55.9%]). In addition, patients with complete pain relief (defined as 0/10 on NRS) were noted at both 2‐week (n = 239, 33%) and 2‐month (n = 130, 18%) follow‐up. In subgroup analysis, the paracentral/subarticular disk group had an increased number of responders, 66.0% in NRS and 64.0% in ODI at 2‐month follow‐up ( P < .05). Conclusions: Two‐level TFESIs are effective in the management of radicular pain, but more research is needed to evaluate the utility of this treatment compared with single‐level TFESI. Our study showed a greater improvement in pain and function as a result of 2‐level TFESIs in the setting of paracentral/subarticular disk herniations. Level of Evidence: IV