Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.06.003
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain

Comparação das técnicas transforaminal e interlaminar de injeções epidurais de esteroides para o tratamento de dor lombar crônica

Serbülent Gökhan Beyaz

http://dx.doi.org/10.1016/j.bjane.2015.06.003 Braz J Anesthesiol, vol.67, n1, p.21-27, 2017
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Abstract

Abstract Study design: A cross-sectional study. Objective: We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Methods: Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Results: Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p < 0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p > 0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. Conclusions: This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals.

Keywords

Transforaminal, Interlaminar, Low back pain, Spinal injection, Complication

Resumo

Resumo Desenho do estudo: Estudo transversal. Objetivo: Comparamos os desfechos de 12 meses de injeções peridurais de esteroides usando a técnica transforaminal (IPETF) guiada por fluoroscopia com as injeções peridurais de esteroides usando a técnica interlaminar (IPEIL) para o tratamento da dor lombar crônica. A dor lombar crônica é uma doença multifatorial com muitas etiologias possíveis. Relata-se que a prevalência de dor na coluna durante a vida é de 65%-80% no pescoço e parte inferior das costas. A injeção peridural de corticosteroides é uma intervenção comumente usada para controlar a dor crônica da coluna vertebral. Métodos: Pacientes que não obtiveram benefício de tratamentos anteriores foram incluídos neste estudo. As injeções foram realizadas de acordo com os achados em Ressonância Magnética (RM) ao nível mais próximo da patologia lombar; 173 pacientes receberam IPEIL e 126 pacientes receberam IPETF. Todos os pacientes foram acompanhados regularmente por 12 meses, usando uma escala numérica verbal (ENV) para a classificação. Achados em RM, complicações, escores ENV e índices de satisfação foram registrados. Resultados: Patologia em disco lombar foi o problema mais frequentemente encontrado. IPEIL foi preferido ao nível intervertebral de L4-L5. Os escores da ENV diminuíram significativamente durante o período de 12 meses em comparação com os valores basais (p < 0,001). Não houve diferenças significativas entre os dois grupos de acordo com a ENV e os índices de satisfação (p > 0,05). Não houve grandes complicações, mas houve complicações menores em 22 (12,7%) no grupo IPEIL e 12 (9,5%) no grupo IPETF. Conclusões: Este estudo mostrou que IPEIL pode ser tão eficaz como IPETF quando realizadas ao nível mais próximo da patologia lombar usando a fluoroscopia em intervalos de 12 meses.

Palavras-chave

Transforaminal, Interlaminar, Dor lombar, Injeção espinhal, Complicação

References

Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician. 2009;12:163-88.

Beyaz SG. Interlaminar lumbar epidural steroid injections in degenerative lumbar spinal stenosis patients. J Clin Anal Med. 2014;5:234-8.

Furman MB, Kothari G, Parikh T. Efficacy of fluoroscopically guided, contrast-enhanced lumbosacral interlaminar epidural steroid injections: a pilot study. Pain Med. 2010;11:1328-34.

Boswell MV, Hansen HC, Trescot AM. Epidural steroids in the management of chronic spinal pain and radiculopathy. Pain Physician. 2003;6:319-34.

Manchikanti L, Boswell MV, Datta S. Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician. 2009;12:E123-98.

Bogduk N. Epidural steroids for low back pain and sciatica. Pain Digest. 1999;9:226-7.

Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991;22:181-7.

Wheeler AH, Murrey DB. Chronic lumbar spine and radicular pain: pathophysiology and treatment. Curr Pain Headache Rep. 2002;6:97-105.

Olmarker K, Nordborg C, Larsson K. Ultrastructural changes in spinal nerve roots induced by autologous nucleus pulposus. Spine (Phila Pa 1976). 1996;21:411-4.

Homma Y, Brull SJ, Zhang JM. A comparison of chronic pain behavior following local application of tumor necrosis factor alpha to the normal and mechanically compressed lumbar ganglia in the rat. Pain. 2002;95:239-46.

Manchikanti L. The growth of interventional pain management in the new millennium: a critical analysis of utilization in the medicare population. Pain Physician. 2004;7:465-82.

Ergin A. Epidural steroid injections and low back pain. Agri. 2005;17:23-7.

Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician. 2006;9:361-6.

Karaman H, Kavak GO, Tüfek A. The complications of transforaminal lumbar epidural steroid injections. Spine (Phila Pa 1976). 2011;36:E819-24.

Goodman BS, Posecion LW, Mallempati S. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med. 2008;1:212-22.

Nawani DP, Agrawal S, Asthana V. Single shot epidural injection for cervical and lumbosaccral radiculopathies: a preliminary study. Korean J Pain. 2010;23:254-7.

Wang JC, Lin E, Brodke DS. Epidural injections for the treatment of symptomatic lumbar herniated discs. J Spinal Disord Tech. 2002;15:269-72.

Ackerman 3rd WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104:1217-22.

Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004;86-A:670-9.

Koes BW, Scholten RJ, Mens JM. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain. 1995;63:279-88.

Karppinen J, Malmivaara A, Kurunlahti M. Periradicular infiltration for sciatica: a randomized controlled trial. Spine (Phila Pa 1976). 2001;26:1059-67.

Vad VB, Bhat AL, Lutz GE. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (Phila Pa 1976). 2002;27:11-6.

White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine (Phila Pa 1976). 1980;5:78-86.

Hopwood MB, Abram SE. Factors associated with failure of lumbar epidural steroids. Reg Anesth. 1993;18:238-43.

Lehmann LJ, Pallares VS. Subdural injection of a local anesthetic with steroids: complication of epidural anesthesia. South Med J. 1995;88:467-9.

Goodman BS, Bayazitoglu M, Mallempati S. Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections. Pain Physician. 2007;10:697-705.

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