The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

Abstract

BackgroundLumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids.MethodsFifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up.ResultsThere were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117).ConclusionsA forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

“…In a study with dexamethasone, the clinical relevance could not be determined. The additional rapid administration of 5 mL 0.9% NaCl after a mixture of 4 mg dexamethasone plus 0.33% lidocaine (3‐mL solutions, 8 mL in total) did not result in better pain relief after 4 weeks in comparison to the dexamethasone mixture of 3 mL …”

“…The additional rapid administration of 5 mL 0.9% NaCl after a mixture of 4 mg dexamethasone plus 0.33% lidocaine (3-mL solutions, 8 mL in total) did not result in better pain relief after 4 weeks in comparison to the dexamethasone mixture of 3 mL. 192 Animal experimental 193 and clinical data 194 often include the phenomenon of endoneural edema with secondary ischemia and electromyographic deviations in the event of traction/pressure on the nerve root. If after correct positioning of the needle tip an exacerbation still occurs during epidural injection of local anesthetics and/ or corticosteroids, it is recommended to inject sufficiently slowly or intermittently.…”

Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

“…We believe that the pathophysiology of spinal stenosis is multifactorial [26]. Although mechanical compression of the spinal canal is a major factor, subjective discomfort, inflammatory effects [27–29], and depression may also contribute to the disease's pain intensity [30]. …”

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

“…Thus, our present results may be limited. Future studies should examine the correlation between the IAPCSA and conventional quantitative radiological criteria for CLSS [26][27][28][29][30][31][32][33][34][35][36][37]. In spite of these limitations, this is the first study to document the association of IAPCSA with CLSS.…”