Purpose:The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. Materials and Methods: A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. Results: One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Conclusion: Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients. symptoms attributed to lumbosacral radiculopathy. In multi-level radiculopathy patients, therapeutic effect of one level epidural steroid injection has been limited. Thus, we focused on additional epidural injections for treating multi-level herniated disc patients. The objectives of our study were comparing the therapeutic effect and complication rates between two level injections and a one level injection along with caudal injection. Index terms MATERIALS AND METHODS PatientsLumbar ESIs were performed from January 2012 to January 2015. Among the patients, 895 consecutive lumbar ESIs in 492 were reviewed. We received approval from Institutional Review Board. Total 895 lumbar ESIs (285 men, 207 women; mean age, 63.9 years) were used for analysis. There is no significant difference in the two groups' age range. The initial Numeric Rating Scale (NRS) score was assessed in every patient (Table 1), dividing them into no, mild (NRS: 1-3), moderate (NRS: 4-6), and severe pain (NRS: 7-10) categories. We classified the patients into two groups based on the NRS anddefined marked improvement with no pain as a satisfactory result for therapeutic effect.Retrospectively, the therapeutic effect difference in the groups was evaluated: one level transforaminal epidural steroid injection (TFESI) along with caudal epidural injection and two level TFESIs for lumbosacral radiculopathy. The inclusion criteria were presence of low...
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