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Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches

박지훈|박기범|정성원|홍지희|박은결
대한통증학회 (The Korean Pain Society)|2017.07|The Korean Journal of Pain|제30권 제3호|pp. 220-228

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참고문헌

키워드

EfficacyRadiation doseEpiduralInterlaminarProcedure timeTransforaminal.

초록

Background: The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI.Methods: A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated.Results: Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm2]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds).Conclusions: ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI. (Korean J Pain 2017; 30: 220-8)

Abstract

Background: The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI.Methods: A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated.Results: Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm2]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds).Conclusions: ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI. (Korean J Pain 2017; 30: 220-8)

참고문헌 (27)

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관련 논문AI추천

Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different ApproachesKuljeet Aujla, Kulvinder Singh, Ruchi Gupta, Saru Singh, Sukhdeep Kaur대한통증학회 · The Korean Journal of Pain2014 · 제27권 제4호Comparison of the Efficacy of Caudal, Interlaminar, and Transforaminal Epidural Injections in Managing Lumbar Disc Herniation: Is One Method Superior to the Other?Frank JE Falco, Joshua A. Hirsch, Laxmaiah Manchikanti, Vidyasagar Pampati, Vijay Singh대한통증학회 · The Korean Journal of Pain2015 · 제28권 제1호Contrast Spread in the Superoposterior Approach of Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy강석, 윤준식, 이충호, 정영철대한재활의학회 · Annals of Rehabilitation Medicine2017 · 제41권 제3호Contrast Spreading Patterns in Retrodiscal Transforaminal Epidural Steroid InjectionChul Kim, Hee Eun Choi, Seonghoon Kang대한재활의학회 · Annals of Rehabilitation Medicine2012 · 제36권 제4호The Prognostic Value of Enhanced-MRI and Fluoroscopic Factors for Predicting the Effects of Transforaminal Steroid Injections on Lumbosacral Radiating Pain김하영, 류주석, 민경훈, 박동휘, 서지현, 오윤걸, 정윤석대한재활의학회 · Annals of Rehabilitation Medicine2016 · 제40권 제6호Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminar versus bilateral transforaminal approachAlp Eren Celenlioglu, Gunay Yolcu, Ipek Saadet Edipoglu, Osman Hakan Gunduz, Savas Sencan대한통증학회 · The Korean Journal of Pain2020 · 제33권 제3호

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