Comparison of Transforaminal Epidural Injections with Conservative Management


A recent study published in Anesthesia Essays and Researches in the January-March 2017 edition compared fluoroscopic guided transforaminal epidural steroid injections to conservative management in patients with chronic lumbar radicular pain.

In this study there were 120 patients. The patients in this study ranged from 18 to 70 years old and were randomly divided into two groups. Each of these patients had back pain for less than one year. They were taking medications such as opioid analgesics, nonsteroidal anti-inflammatory drugs, or neuropathic medications such as Lyrica for low back pain associated with unilateral (one-sided) leg pain, symptoms suggestive of sensory impairment in the affected lamb, and imaging suggestive of spinal stenosis or herniated/degenerated disc, and patients with positive straight leg raise test.

By the end of one month, the straight leg raise test had become negative in 98% of those treated with transforaminal epidural steroid injections compared with only 72% of those treated with conservative care.

In regards to becoming pain free, 93.33% of the transforaminal epidural steroid group was pain-free at one month compared with only 23.33% of the conservative care group at one month. The statistical value of this study is highly significant with a P value <0.0001.

The amount of drug required for pain control was also markedly reduced in the transforaminal study group. The average amount of medication reduction in the transfer in group was 94.33% compared with 72.17% in the conservative care group. Again, the findings were highly statistically significant.

The authors concluded that it is, therefore, a reasonably safe procedure to provide short-term pain relief and allow patients to remain active with much reduced analgesic requirements and its associated systemic side effects.

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