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Published on: August 7, 2018
A Retrospective Comparative Analysis of Transforaminal Epidural Steroid Injections and Percutaneous Transforaminal
Jian Zhou1, An'nan Hu1, Xiaogang Zhou1
1Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
Purpose:
The rising global population aged over 80 has increased the incidence of degenerative spinal conditions causing lumbar radiculopathy. Minimally invasive treatments such as transforaminal epidural steroid injection (TESI) and percutaneous transforaminal endoscopic discectomy (PTED) are commonly used, yet their comparative effectiveness remains unclear. This study aimed to compare the clinical outcomes, safety, and efficacy of TESI and PTED in patients aged 80 and above.
Patients And Methods:
A retrospective analysis was conducted on 74 patients with conservative treatment-resistant lumbar radiculopathy. Patients were divided into TESI (n=40) and PTED (n=34) groups. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-BP, VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. Secondary outcomes were operative time, fluoroscopy frequency, hospital stay, and complications. Assessments occurred preoperatively and at 1 week, 1, 3, 6, and 12 months post-procedure. Statistical analyses used ANOVA and chi-square tests.
Results:
Both groups showed significant short-term improvement. At 6- and 12-month follow-ups, the PTED group demonstrated superior and sustained outcomes, with greater pain reduction (VAS-BP, VAS-LP), better functional improvement (ODI), and higher excellent/good MacNab rates (87.9% vs 64.9%, p<0.05) compared to TESI. The TESI group had a higher recurrence rate (21.62% vs 6.06%). TESI was associated with shorter procedure times and hospital stays. No serious complications occurred in either group.
Conclusion:
Both TESI and PTED are effective minimally invasive treatments for lumbar radiculopathy in very elderly patients. TESI offers quicker procedures and rapid symptom relief, while PTED provides more durable pain reduction and functional improvement. Treatment plans should be tailored to each individual, in accordance with established geriatric care principles that emphasize the consideration of comorbid conditions, specific pathology, and patient preferences. Further prospective randomized studies are needed to confirm these results.
