Three week results of transforaminal epidural steroid injection in patients with chronic unilateral low back related leg pain: The relation to MRI findings and clinical features

Abstract

Abstract. BACKGROUND:Transforaminal epidural steroid injection (TESI) is a frequently used intervention for lumbar radicular pain. OBJECTIVE: To evaluate the value of MRI findings, neurologic assessment and the Slump test (neurodynamic test) as predictors of treatment response to TESI. METHOD: One hundred subjects (mean age 58 [SD13], 54% females) were included in this trial. The sample was stratified by location of disc herniaton, grade of nerve root compression, clinically assessed neurologic deficit and positive Slump test. Treatment response was primarily evaluated by Visual Analogue Scale for leg pain after three weeks. Predictive value for each stratum was analyzed using logistic regression after the sample was dichotomized into definite treatment response ( 50% reduction of pain) and negative response ( 0% reduction) to TESI (the 1-49% reduction group was excluded). RESULTS: The overall definite treatment response rate was 27%. The Slump test was the only predictor of the response to TESI (p = 0.031). The definite treatment response rates for subjects with positive and negative Slump test were 33% and 15%, respectively. CONCLUSION: In patients with chronic low back related leg pain, MRI findings and neurologic assessment results failed to predict treatment response, whereas a positive Slump test predicted the best 3-week response to TESI.

Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica

“…In addition, Ekedahl et al [21] found that high-grade nerve root compression was a strong predictor of adverse treatment outcomes during one-year follow-up. On the other hand, some authors have suggested that there is no correlation between spinal nerve root compression and treatment response [13,19], and this was consistent with our study findings. In our study we included patients with subarticular/central herniation and excluded those with foraminal herniation; therefore, we were unable to evaluate foraminal compression.…”

“…This indicates that there are several factors which affect treatment success. A number of studies have been carried out to investigate the clinical and radiological parameters which can affect TFESI outcomes [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. These studies have shown that the duration of symptoms before TFESI has an effect on treatment outcomes with an inverse correlation between duration of pretreatment symptoms and treatment outcomes [11,16,21].…”

Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy

“…However, a central canal stenosis observed on MRI may be associated with increased odds of a positive response, even though the association was not statistically significant in multivariate analysis. These associations have been disputed in previous studies [19,22,23,27,28]. Other variables, including age, sex, the presence of trauma or sprain, the location of pain, neurogenic claudication and findings of physical examination, cannot be considered as predictors of short-term outcome after a TFESI.…”

“…Despite the widespread availability of epidural steroid injections, little is known about the factors predicting their success. Studies investigating the predictors of lumbar epidural steroid injections have shown conflicting results [9,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. If the diagnostic information can be used to predict treatment response, it can facilitate the treatment plan.…”

The influence of nociceptive and neuropathic pain states on the processing of acute electrical nociceptive stimulation: A dynamic causal modeling study

“…Patients with nociceptive LBLP (Ekedahl et al, 2016;Harrisson et al, 2017;Konstantinou et al, 2018), aged 18-65 years, were recruited at the department of neurosurgery from the University Hospital Brussels. Patients with lumbar radicular nociceptive pain, with an indication for spine surgery, were contacted to participate (Adebajo and Fabule, 2012).…”