Effectiveness of Transforaminal Epidural Steroid Injections in Low Back Pain: A One-Year Experience

Original Contribution

Samuel K. Rosenberg, MD, Andreas Grabinsky, MD, Christine Kooser, RN and Mark V. Boswell, MD, PhD

Anesthesia Pain Service, Department of Anesthesiology, University Hospitals of Cleveland, Cleveland, Ohio.

Transforaminal epidural steroid injections under fluoroscopy are an alternative treatment for lower back pain with radiculopathy. We followed 82 patients with a stand-ardized telephone questionnaire at 2, 6, and 12 months after the first injection, in order to assess their effectiveness.

Ninety-two patients with radiculopathic back pain due to spinal stenosis, herniated discs, spondylolisthesis, and degenerated discs, underwent transforaminal epidural steroid injections under fluoroscopy. Eighty-two patients were followed with a standardized telephone questionnaire. The population was divided into four groups: Group I, previous back surgery (16%); Group II, discogenic abnormalities: herniations, bulges, or degeneration, (42%); Group III, spinal stenosis (32%); Group IV, those without MRI (11%).

Age ranged between 24 to 99 years, mean 64.5. Forty-seven were female, 35 male. Thirteen patients (16%) underwent one procedure, 27 patients (33%) two, 37 patients (45%) three, and five patients (6%) four, an average 2.4 procedures per patient. The pain scores for all patients improved significantly at all three time points (2, 6 and 12 months) compared to the initial mean pain score of 7.3 to mean pain scores of 3.4, 4.5 and 3.9 respectively. After one year, 36 patients did not take any pain medications. Greater than 50% improvement after one year was seen in 23% of Group I; 59% in Group II; 35% in Group III and 67% in Group IV.

Transforaminal epidural steroid injections can offer significant pain reduction up to one year after initiation of treatment in patients with discogenic pain and possibly in patients with spinal stenosis.