Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia ? a prospective, randomised, double-blind study

Abstract

A prospective, randomised, double-blind study was carried out to compare the respective efficacies of transforaminal and interspinous epidural corticosteroid injections in discal radiculalgia. Thirty-one patients (18 females, 13 males) with discal radicular pain of less than 3 months' duration were consecutively randomised to receive either radio-guided transforaminal or blindly performed interspinous epidural corticosteroid injections. Post-treatment outcome was evaluated clinically at 6 and 30 days, and then at 6 months, but only by mailed questionnaire. At day 6, the between-group difference was significantly in favour of the transforaminal group with respect to Schober's index, finger-to-floor distance, daily activities, and work and leisure activities on the Dallas pain scale. At day 30, pain relief was significantly better in the transforaminal group. At month 6, answers to the mailed questionnaire still showed significantly better results for transforaminal injection concerning pain, daily activities, work and leisure activities and anxiety and depression, with a decline in the Roland-Morris score. In recent discal radiculalgia, the efficacy of radio-guided transforaminal epidural corticosteroid injections was higher than that obtained with blindly-performed interspinous injections.

Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias

“…Según algunos estudios se evitaría la cirugía hasta en 50% de los casos y en los casos en los que no se evita se observa un retraso de la misma de entre 13 y 28 meses. Ahora, en caso que exista una buena respuesta a la inyección epidural del punto de vista del dolor (> 50% alivio), existe > 90% de probabilidades que el dolor se alivie en forma signifi cativa posterior a cirugía y que este alivio se mantendrá por más de 6 meses [11][12][13][14][15][16] .…”

Estudo clínico da eficácia do bloqueio anestésico radicular transforaminal no tratamento da radiculopatia lombar

“…O estudo realizado por Thomas et al 18 demonstrou que a injeção transforaminal de corticosteróide com controle radioscópico prevê melhor alívio da dor (EAV), e apresenta maior eficácia quando comparado a injeção intraespinhosa. Isso justifica a técnica usada em nosso estudo com a segmentação da raiz nervosa selecionada para injeção da solução sob fluoroscopia.…”

Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives

“…Carried to its logical conclusion, the target specific theory would suggest a preference for transforaminal injections. While evidence supports this argument in the lumbar spine [11,12], it has never been demonstrated in the cervical spine.…”

“…In the lumbar spine, evidence suggests that epidural injections are effective in reducing pain and need for surgery. In addition, randomized controlled trials demonstrate that outcomes of lumbar transforaminal injections are superior to lumbar interlaminar injections [11,12]. Currently, the efficacy of cervical epidural injections, both interlaminar and transforaminal, remains unknown because neither has been tested against a placebo.…”

“…Transforaminal injections in the cervical spine were more recently developed as a more target-selective alternative, and initially were presumed to provide advantages for safety and effectiveness [10][11][12]. A cervical transforaminal injection requires placement of a needle into the neuroforamen from an anterolateral approach.…”