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Fluoroscopy-Guided Transforaminal versus Caudal Epidural Steroid Injection for Chronic Pain After Spinal Surgery: A
Jun Hyeong Song1, Woo Yong Lee2, Kyoung Rai Cho3
1Department of Physical Medicine & Rehabilitation, Sanggye Paik Hospital, Inje UniversityCollege of Medicine, Seoul, Republic of Korea.
Journal of Pain Research
|July 21, 2021
Summary
Fluoroscopy-guided caudal epidural steroid injections (ESI) offer similar pain relief and functional improvement for chronic post-surgical pain compared to transforaminal ESI. Caudal ESI is quicker and leads to higher patient satisfaction.
Area of Science:
- Pain Management
- Interventional Pain Medicine
- Spinal Procedures
Background:
- Chronic pain after spinal surgery (CPSS) significantly impacts patient functionality.
- Epidural steroid injections (ESI) are utilized to manage CPSS.
- Fluoroscopy guidance is standard for ESI procedures.
Purpose of the Study:
- To compare the efficacy, safety, and mid-term outcomes of fluoroscopy-guided transforaminal (TF) versus caudal (CA) epidural steroid injections (ESI) for CPSS.
- To assess pain relief and functional improvement following ESI procedures.
Main Methods:
- Retrospective study of patients with radicular pain in CPSS receiving FL-guided CA-ESI (n=21) or TF-ESI (n=28).
- Comparison of complication frequencies, adverse events, treatment effects, and functional improvements at 1, 3, and 6 months post-injection.
- Evaluation of patient satisfaction within two weeks of treatment.
Main Results:
- Both CA-ESI and TF-ESI groups showed significant improvements in Oswestry Disability Index (ODI) and verbal numeric pain scale (VNS) scores at all time points, with no meaningful difference between groups.
- Procedure time was significantly shorter for CA-ESI compared to TF-ESI (410.32 ± 25.73s vs 640.65 ± 18.03s).
- Patient satisfaction was significantly higher in the CA-ESI group (85.7%) compared to the TF-ESI group (55.7%) within two weeks.
- No significant adverse complications were reported in either group.
Conclusions:
- Fluoroscopy-guided caudal (CA) and transforaminal (TF) epidural steroid injections (ESI) demonstrate comparable mid-term effectiveness in pain reduction and functional improvement for chronic post-surgical pain (CPSS).
- CA-ESI offers advantages of reduced procedure time and enhanced patient satisfaction compared to TF-ESI.
- Both CA-ESI and TF-ESI are effective treatment options for CPSS, with CA-ESI presenting a more favorable patient experience and procedural efficiency.
