Ann Rehabil Med.  2016 Dec;40(6):1071-1081. 10.5535/arm.2016.40.6.1071.

The Prognostic Value of Enhanced-MRI and Fluoroscopic Factors for Predicting the Effects of Transforaminal Steroid Injections on Lumbosacral Radiating Pain

• Jung YS
• Suh JH
• Kim HY
• Min K
• Oh Y
• Park D
• Ryu JS

• KMID: 2371340
• DOI: http://doi.org/10.5535/arm.2016.40.6.1071

Abstract

OBJECTIVE
To investigate the predictive value of enhanced-magnetic resonance imaging (MRI) and fluoroscopic factors regarding the effects of transforaminal epidural steroid injections (TFESIs) in low back pain (LBP) patients with lumbosacral radiating pain.
METHODS
A total of 51 patients who had LBP with radiating pain were recruited between January 2011 and December 2012. The patient data were classified into the two groups "˜favorable group' and "˜non-favorable group' after 2 weeks of follow-up results. The favorable group was defined as those with a 50%, or more, reduction of pain severity according to the visual analogue scale (VAS) for back or leg pain. The clinical and radiological data were collected for univariate and multivariate analyses to determine the predictors of the effectiveness of TFESIs between the two groups.
RESULTS
According to the back or the leg favorable-VAS group, the univariate analysis revealed that the corticosteroid approach for the enhanced nerve root, the proportion of the proximal flow, and the contrast dispersion of epidurography are respectively statistically significant relative to the other factors. Lastly, the multiple logistic regression analysis showed a significant association between the corticosteroid approach and the enhanced nerve root in the favorable VAS group.
CONCLUSION
Among the variables, MRI showed that the corticosteroid approach for the enhanced target root is the most important prognostic factor in the predicting of the clinical parameters of the favorable TFESIs group.

Keyword

Low back pain; Epidural injections; Magnetic resonance imaging; Intervertebral disc displacement

MeSH Terms

Follow-Up Studies
Humans
Injections, Epidural
Intervertebral Disc Displacement
Leg
Logistic Models
Low Back Pain
Magnetic Resonance Imaging
Multivariate Analysis

Figure

• 

  Fig. 1 Presence of the enhancement of the nerve root (arrow) in a comparison between the magnetic resonance imaging (MRI) axial T2-weighted (A) and axial T1-weighted (B) gadolinium-enhanced images.

• 

  Fig. 2 The epidural enhancement of magnetic resonance imaging (MRI) scans. (A) Sagittal T2-weighted images of L4/5 herniated disc, (B) L2/3 normal disc, and (C) L4/5 herniated disc with epidural enhancement (arrow) in axial T1-weighted gadolinium-enhanced images.

• 

  Fig. 3 Illustration of the three contrast-dispersion patterns in comparison with the fluoroscopic epidurography. (A) Type 1, intraepineural pattern; type 2, extraepineural pattern; and type 3, paraneural pattern (modified from Pfirrmann et al. [16] with permission of the Radiological Society of North America). (B–D) Fluoroscopic-epidurography images are in sequence: (B) intraepineural, (C) extraepineural, and (D) paraneural patterns.

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