J Korean Soc Radiol.  2017 Jan;76(1):48-53. 10.3348/jksr.2017.76.1.48.

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

• Hwang J
• Hwang CM
• Cho YJ
• Kim KW
• Kim YJ
• Seo JY
• Lim SJ
• Kang BS

• KMID: 2365051
• DOI: http://doi.org/10.3348/jksr.2017.76.1.48

Abstract

PURPOSE
The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient.
MATERIALS AND METHODS
A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months.
RESULTS
One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01).
CONCLUSION
Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients.

MeSH Terms

Follow-Up Studies
Humans
Injections, Epidural*
Low Back Pain
Radiculopathy*
Spine
Therapeutic Uses
Therapeutic Uses

Figure

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  Fig. 1 Radiographs of 69-year-old man with radiating pain to right buttock and lower leg in the S1 dermatome. MR image (not shown) revealed right L4/5 and L5/S1 disc herniations with compression of right L5/S1 nerve root. Initial NRS score is 10 point. The patient received one level TFESI, he experienced less pain for approximately 1 months (NRS: 6). PA spot radiograph shows contrast material has spread to the epidural space. NRS = Numeric Rating Scale, PA = posteroanterior, TFESI = transforaminal epidural steroid injection

• 

  Fig. 2 Radiographs of 65-year-old man with severe back pain and radiating pain to right buttock. The patient received one level TFESI along with caudal epidural injection. Initial NRS score is 10 point. The patient received one level TFESI and ESI, he experienced no residual pain for approximately 1 months (NRS: 0). After on PA spot radiographs during TFESI, the spinal needle is located in the sacral canal, and the contrast agent is spreading into the epidural space of the lumbar spine. ESI = epidural steroid injection NRS = Numeric Rating Scale, PA = posteroanterior, TFESI = transforaminal epidural steroid injection

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