Korean J Pain.  2020 Jul;33(3):226-233. 10.3344/kjp.2020.33.3.226.

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar versus bilateral transforaminal approach

• Sencan S
• Edipoglu IS
• Celenlioglu AE
• Yolcu G
• Gunduz OH

• KMID: 2504068
• DOI: http://doi.org/10.3344/kjp.2020.33.3.226

Abstract

Background
We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS).
Methods
The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure.
Results
A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020).
Conclusions
Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.

Keyword

Chronic Pain; Depression; Injections, Epidural; Low Back Pain; Lumbosacral Region; Neuralgia; Pain Management; Patient Outcome Assessment; Spinal Stenosis

Figure

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  Fig. 1 Percentage of patients showing NP (DN4 score > 4) at different time intervals in ILESI and TFESI groups. Cochran Q and chi-square test were used for comprasion of in groups and between groups, respectively. NP: neuropathic pain, DN4: douleur neuropathique en 4 questions, ILESI: interlaminar epidural steroid injection, TFESI: transforaminal epidural steroid injection. *Patients with neuropathic pain were significantly reduced from baseline in TFESI group at week 3 (P < 0.05).

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