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Comparative effectiveness of transforaminal epidural steroid injection: subpedicular versus Kambin's triangle
Wongthawat Liawrungrueang1,2, Sung Tan Cho3, Jaruphitchaya Homlakhorn2
1Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand.
Background:
Transforaminal epidural steroid injection (TFESI) is a widely employed intervention for managing radicular pain associated with spinal pathology. Among the various techniques utilized for TFESI, the subpedicular and Kambin's triangle approaches are prominent. This study aims to comprehensively evaluate and compare the therapeutic effectiveness and safety profiles of these two techniques of TFESI in alleviating pain and improving functional outcomes.
Methods:
A retrospective analysis of 100 patients with unilateral radicular leg pain due to single-level lumbar disc herniation (LDH) was conducted. Patients were categorized into two groups: subpedicular TFESI (n=50) and Kambin's triangle TFESI (n=50). Pain intensity was assessed using the numerical rating scale (NRS), and functional outcomes were evaluated via the Oswestry Disability Index (ODI). Data were collected at baseline, immediate post-procedure, and follow-ups at 1, 3, 6, and 8 months. Adverse events, procedure duration, and costs were also analyzed.
Results:
Both groups showed significant improvements in NRS and ODI scores from baseline to final follow-up (P<0.001). The mean operation time was 25.55±2.01 min for the subpedicular technique and 24.16±3.56 min for the Kambin's triangle technique, with no significant difference (P=0.23). Similarly, treatment costs were comparable (mean 214±5.32 vs. 211±4.36 USD; P=0.43). No significant differences in pain relief, functional improvement, or adverse event rates were observed between the two techniques.
Conclusions:
Both the subpedicular and Kambin's triangle techniques for TFESI show comparable efficacy and safety in managing radicular leg pain from LDH. Clinicians can select either method based on patient-specific factors and surgeon preference. However, additional prospective studies are necessary to validate these results and further inform clinical decision-making.
