Fluoroscopic transforaminal lumbar epidural steroids: An outcome study

Outcomes of a prospective cohort study on peri-radicular infiltration for radicular pain in patients with lumbar disc herniation and spinal stenosis

“…Our study used a mixture of 2 ml 0.25% bupivicaine and 40 mg methylprednisolone, which is the same as the mixture used by Karppinen et al [11] and Riew et al [27]. The use of short-term acting injection of 1.5 ml 2% xylocaine with 9 mg betamethasone acetate by Lutz et al [15] produced a successful outcome with a 50% reduction in VAS in 75% of the patients. We chose methylprednisolone for its predominant anti-inflammatory effect with little sodium-retaining activity.…”

“…Since then, various different terminologies have been used in the literature, which include 'selective lumbosacral block' [29], 'selective nerve root blocks' [14,26], 'transforaminal epidural injections' [15,28] and 'peri-radicular infiltration' [11].…”

“…However, there is evidence suggesting that multiple peri-radicular infiltration can prolong its effects. Lutz et al [15] were able to achieve a success rate of 75% at an average of 80-month follow-up when multiple injections are combined with a functional restoration program that emphasized active exercise and education. Riew et al [27] also found that by implementing multiple injection regimes, 52.7% of the patients can avoid the need for operative intervention for up to 13-28 months.…”

“…We chose methylprednisolone for its predominant anti-inflammatory effect with little sodium-retaining activity. Lutz et al [15] chose to use betamethasone that is longer acting than methylprednisolone. However, there is currently no study to suggest which is best in terms of the treatment outcome.…”

“…Tajima et al [29] later explored its therapeutic value and reported their results in 1980. Four studies conducted by Weiner et al [33], Lutz et al [15], Pfirrmann et al [26] and Karppinen et al [11] in the last decade have all demonstrated its value in relieving discogenic sciatic pain. However, there are relatively few prospective studies [3,27] that examine its efficacy in relieving stenotictype radicular pain.…”