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Comparison of Effect and Contrast Spreading in Transforaminal Epidural Injection Using the Retrodiscal Versus
Hyun Seung Jin1, Geon Hyeong Bae2, Eun Joo Choi2
1The Comfortable Pain Clinic.
Pain Physician
|January 6, 2023
Summary
The retrodiscal (RD) approach for lumbar transforaminal epidural injection (TFEI) demonstrates superior contrast spread compared to the subpedicular (SP) approach, particularly in severe spinal stenosis cases. This suggests the RD approach may offer enhanced short-term pain relief for these patients.
Area of Science:
- Interventional Pain Management
- Spinal Imaging and Intervention
- Neurosurgery and Orthopedics
Background:
- Lumbar transforaminal epidural injection (TFEI) is effective for managing low back pain and radicular pain associated with herniated intervertebral disc (HIVD) and spinal stenosis (SS).
- Optimal drug delivery to the target site is crucial for effective pain management and minimizing potential complications during TFEI procedures.
Purpose of the Study:
- To compare the efficacy and complication rates of the subpedicular (SP) and retrodiscal (RD) approaches for TFEI.
- To analyze contrast spread patterns into the target area using a novel grading system and assess the influence of spinal disease severity on these patterns.
Main Methods:
- A prospective, randomized, observational study was conducted at an interventional pain management center.
- Patients with lumbar spinal stenosis or HIVD at L4/L5 were randomized to undergo TFEI via either the SP or RD approach.
- Contrast spread patterns were analyzed using a 4-grade system following injections of 0.5 mL to 3.0 mL of contrast media; pain relief (VAS) and complications were also assessed.
Main Results:
- Both SP and RD groups showed significant pain reduction at 2 and 4 weeks post-procedure, with no significant difference between the groups.
- A 1.5-mL contrast injection revealed a significantly higher rate of Grade 3 spread in the RD group (17.2%) compared to the SP group (8.2%).
- The RD group demonstrated superior contrast spread (more Grade 3 and 4) in patients with severe central and foraminal spinal stenosis at specific injection volumes.
Conclusions:
- The retrodiscal (RD) approach for TFEI exhibits a more favorable contrast spreading pattern than the subpedicular (SP) approach.
- The RD approach appears particularly beneficial for patients with severe central and foraminal spinal stenosis, potentially leading to better short-term outcomes.
- Further research with longer follow-up periods is warranted, given the study's 4-week follow-up and use of higher contrast volumes.
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