Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

Abstract

Background:The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods:We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers' compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results:We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers' compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion:Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.

Effect Of Transforaminal Anterior Epidural Steroid Injection On Neuropathic Pain, Quality Of Sleep And Life

“…While it has been found that the chance of success of TAESI is higher in the case of pain lasting for shorter periods, the effectiveness of the procedure in patients who have been experiencing chronic pain for longer periods is controversial. [26] In earlier publications, cases not cured within 3-6 months were accepted as chronic low back pain whereas the more recent literature has brought this period down to 7-8 weeks. In the present study, 60% of the patients had been experiencing pain for more than one year prior to the procedure.…”

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

“…Although there is still substantive criticism, the latest reviews usually point in the same direction: there is proof of moderate to high quality that epidural corticosteroids have a significant but clinically limited effect on lumbosacral radicular pain in comparison with a placebo on leg pain and function during the first weeks, but this effect disappears after 3 months . There are indications that surgery can be avoided in 1 study that assessed this as the primary outcome parameter and various studies that included this as a secondary outcome parameter, although the latter is inconsistent …”

Epidural Steroids

“…Along with the controlled studies, several uncontrolled studies performed by spine surgeons evaluating surgery as a primary outcome measure have also found a surgery-sparing effect for ESI. 164,165 In contrast, the large majority of randomized controlled studies evaluating surgery rates as a secondary outcome measure failed to find a difference in operative rates between ESI and placebo treatment, 99, 137,145,146,166Y178 compared with the few that did. 179,180 The difficulty in evaluating surgery rates as a secondary outcome is that nearly all studies are underpowered to detect a difference and incorporate some degree of bias through patient selection.…”