Short-term assessment of periradicular corticosteroid injections in lumbar radiculopathy associated with disc pathology

Abstract

We evaluated periradicular injection of corticosteroids performed by neuroradiologists under fluoroscopic guidance in the treatment of lumbosacral nerve root pain in 40 patients (average age 48 years) presenting with lumbosciatica or radiculopathy not responding to conservative treatment. Patients with root pain due to infectious, neoplastic or inflammatory diseases were excluded, as were patients who needed immediate surgery. Pain was evaluated using a visual analogue scale (VAS) 10 and 90 days after the injection. After 10 days a substantial decrease in root pain was observed, with a statistically significant decrease in mean VAS. This decrease was observed in 90% of patients, and it persisted after 90 days in 85%. Side effects were rare, mild and disappeared spontaneously. They were related to the drug injected (corticosteroids).

Nerve root infiltration of the first sacral root with MRI guidance

“…The outcome was not evaluated separately for lumbar and sacral nerve roots in these studies. In our series the outcome of the first sacral root infiltration was in accordance with these other studies of lumbosacral roots using fluoroscopy or CT guidance (3,4,7,27). Our unpublished controlled trial is in accordance with these earlier studies (28).…”

“…Since 1995 over 1400 nerve root infiltrations have been performed with fluoroscopy guidance in our institution, and in our experience this method allows the needle to be placed only into the dorsal root canal or dorsal root sheath of the first sacral root; the depth is difficult to estimate. The technical difficulties with S1 root infiltration have been confirmed by Viton et al (7). Compared with CT guidance, MRI allows better three-dimensional imaging capability and produces no radiation.…”

“…To our knowledge this is the first study to evaluate only the first sacral root infiltration. Other studies (3,4,7,27) evaluated the outcome of first sacral root and lumbar root infiltrations together. In our C-arm MRI guidance system, we were able to infiltrate the treatment agent directly into the main, ventral ramus sheath of the first sacral root.…”

“…However, the unavoidable ionizing radiation risk, the need for a contrast agent, and the low soft tissue contrast tend to mitigate against these methods. Moreover, infiltration of the S1 root is technically unsatisfactory by fluoroscopy (7).…”

Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain

“…Lutz et al have reported that patients with pre-injection symptom durations of less than 36 weeks were most likely to respond to treatment (18). Viton et al have found that the decrease in pain was greater for the patients less than 50 years of age than for the older patients after TESI for lumbar radiculopathy (27). In our series, the symptom duration and age of the patients had no significant association with pre-procedural or short term or long term post-procedural clinical status.…”