Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective...

Area of Science:

• Pain Management
• Neurosurgery
• Radiology

Background:

• Lumbosacral radiculopathy is a common cause of low back pain and radiating leg pain.
• Transforaminal epidural steroid injection (TFESI) is a frequently used minimally invasive procedure for managing radicular pain.
• Optimizing TFESI technique is crucial for maximizing therapeutic outcomes.

Purpose of the Study:

• To prospectively compare the short- and midterm effectiveness of TFESI for lumbosacral radiculopathy based on injection level.
• To determine if a preganglionic or ganglionic approach yields superior results.

Main Methods:

• A prospective study involving 239 patients undergoing lumbar TFESI.
• Patients were randomized into two groups: ganglionic (targeting the exiting nerve root) or preganglionic (targeting the supra-adjacent intervertebral disk level).
• Outcomes were assessed using visual analog and four-grade scales at short-term (1 month) and midterm (>6 months) follow-ups. Statistical analyses included univariate and multiple logistic regression.

Main Results:

• The preganglionic group demonstrated significantly better short-term treatment effects (88.4%) compared to the ganglionic group (70.9%) (P = .001).
• Injection level was the only significant predictor of short-term outcomes (odds ratio = 2.232, P = .037).
• No significant differences in TFESI approach or cause of radiculopathy were found at midterm follow-up.

Conclusions:

• TFESI utilizing a preganglionic approach is more effective than a ganglionic approach for short-term pain relief in lumbosacral radiculopathy.
• The injection level is a critical factor influencing short-term treatment success.
• Further research may be needed to understand midterm outcomes and long-term efficacy.