Comparison of Two Methods of Epidural Steroid Injection in the Treatment of Recurrent Lumbar Disc Herniation

Abstract

Study DesignProspective study.PurposeWe compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation.Overview of LiteratureTo our knowledge, there is no previous report of such a comparison in these patients.MethodsThe study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection.ResultsThe degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods.ConclusionsIn the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences.

Therapeutic effect of percutaneous endoscopic lumbar discectomy on lumbar disc herniation and its effect on oxidative stress in patients with lumbar disc herniation

“…However, this treatment usually brings relatively large trauma to patients and may also damage the patient's spinal stability and induce complications. Thus, the application of this treatment is limited (2,3). How to reduce surgical trauma, maintain the integrity and stability of spine and reduce the incidence of postoperative complications is a difficult point for the treatment of lumbar disc herniation.…”

The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain

“…Three 30 , 32 , 37 of the 5 studies demonstrated that the TF groups experienced significantly better pain relief than the C groups. The remaining study 33 , 34 observed no difference between the 2 groups. Ackerman and Ahmad 2 observed better pain relief in the TF group at 24 weeks.…”

“…Galhom and al-Shatouri 32 reported that only 20% of the patients developed complications and that soreness at the injection site was the most common complication. Karamouzian et al 33 found that only 1 patient suffered temporary paraparesis in the C group. Mendoza-Lattes et al 29 did not observe the occurrence of complications; however, they reported that 10 of 39 patients required reinjection in the C group, in addition to 10 of 54 in the TF group.…”

“…The particular information of the risk of bias of the included articles is demonstrated in Figure 4 . Four 2 , 30 , 33 – 34 of the 6 studies comprehensively described the generation of a randomized sequence, and the remaining studies 32 , 37 did not demonstrate the randomization method. The patients were not blinded to treatment allocation in 1 study.…”

Safety of Epidural Steroid Injection Methods in the Management of Recurrent Lumbar Disc Herniation: Few Comments

“…We were recently interested by an article published in the Asian Spinal Journal by Karamouzian et al [ 1 ], entitled "Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation". The authors presented an intriguing investigation comparing the effectiveness of the different methods of epidural steroid injection (ESI) in patients with recurrent lumbar disc herniation, and reported similar outcomes of transforaminal and caudal steroid injection procedures in the treatment of lumbar disc herniation.…”