Fluoroscopically Guided Lumbar Transformational Epidural Steroid Injections in Degenerative Lumbar Stenosis

Authors:
  • RGRobert D. Gruber
    Robert D. Gruber
  • CBConstantine G. Bouchlas
    Constantine G. Bouchlas
  • FTFrancisco M. Torres-Ramos
    Francisco M. Torres-Ramos
  • JSJoseph T. Sanelli
    Joseph T. Sanelli
  • EFEric D. Freeman
    Eric D. Freeman
  • WSWarren K. Slaten
    Warren K. Slaten
  • SRSanjiv Rao
    Sanjiv Rao
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Abstract
To identify the short- and long-term therapeutic benefit of fluoroscopically guided lumbar transforaminal epidural steroid injections in patients with radicular leg pain from degenerative lumbar stenosis. This prospective cohort study performed at a multidisciplinary spine center. There were a total of 34 patients who met our inclusion criteria for the treatment of unilateral radicular pain from degenerative lumbar spinal stenosis who underwent fluoroscopically guided lumbar transforaminal epidural injections. Patients with radiculopathy, who did not respond to physical therapy, antiinflammatories, or analgesics, caused by degenerative lumbar stenosis and confirmed by magnetic resonance imagining received fluoroscopically guided lumbar transforaminal epidural steroid injections at the presumed symptomatic nerve root. The injectant consisted of 12 mg of betamethasone acetate and 2 ml of 1% preservative-free lidocaine HCL. Patients were evaluated by an independent observer and received questionnaires before the initial injection, at 2 mo, and at 12 mo after the injections. Questionnaires included a visual analog scale, Roland 5-point pain scale, standing/walking tolerance, and patient satisfaction scale. A total of 34 patients met our inclusion criteria and were followed for 1 yr. Seventy-five percent of patients had successful long-term outcome, reporting at least a >50% reduction between preinjection and postinjection pain scores, with an average of 1.9 injections per patient. Sixty-four percent of patients had improved walking tolerance, and 57% had improved standing tolerance at 12 mo. Fluoroscopically guided transforaminal epidural steroid injections may help reduce unilateral radicular pain and improve standing and walking tolerance in patients with degenerative lumbar spinal stenosis.

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