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A Novel Scoring System for Predicting Procedural Difficulty in Supraneural L5 TFESI: The L5 TFESI Difficulty Score
1Department of Physical Medicine and Rehabilitation, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Summary
A new grading system (LTDS) helps predict technical difficulty for L5 supraneural transforaminal epidural steroid injections (TFESI). Higher scores indicate increased difficulty, aiding preprocedural planning for patients with lumbar degeneration.
Area of Science:
- Pain Management
- Interventional Radiology
- Spinal Anatomy
Background:
- Lumbosacral radiculopathy is commonly treated with L5 supraneural transforaminal epidural steroid injections (TFESI).
- Anatomical variations like osteophytes can complicate L5 TFESI and affect injectate delivery.
- A standardized system to grade anatomical complexity for L5 TFESI is lacking.
Purpose of the Study:
- To develop and validate a grading system (LTDS) to quantify anatomical complexity for L5 supraneural TFESI.
- To assess the LTDS's ability to predict technical difficulty and procedural outcomes.
Main Methods:
- A retrospective study of 584 L5 supraneural TFESI procedures in patients over 60.
- Development of the Lumbar Transforaminal Difficulty Score (LTDS) based on six fluoroscopic criteria.
- Stratification into LTDS groups (Low, Middle, High) and ROC analysis to evaluate predictive performance.
Main Results:
- Higher LTDS scores correlated with longer procedure times and reduced optimal TFESI execution.
- Each LTDS point increase decreased successful injection odds by ~40% (AUC=0.707).
- The LTDS demonstrated high inter- and intra-rater reliability (Cronbach's α > 0.88).
Conclusions:
- The LTDS effectively stratifies technical difficulty in L5 supraneural TFESI.
- The LTDS serves as a practical decision-support tool for preprocedural planning and operator training.
- This system is valuable for patients with advanced lumbar degeneration undergoing L5 TFESI.
